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LIBRARY OF CONGRESS, 
Shelf .....SA-' 



UNITED STATES OF AMERICA. 





THE 



General Practitioner. 



A MANUAL 



FOR THE PRACTICE OF MEDICINE, EMBRACING NEARLY ALL 
THE DISEASES OF THE VARIOUS BRANCHES OF THE 
HEALING ART, WITH THEIR SEVERAL DEFI- 
NITIONS, SYMPTOMS AND CAUSES. 



THE DESCRIPTIVE PART 

OF THE WORK IS PRECEDED BY A CHOICE COLLECTION OF REMEDIES 
IN THE FORM OF 



Select Prescriptions, 



WITH FULL NOTES OF THEIR PROPERTIES AND VALUE, AND CLEARLY STATED 
RULES AS TO THE MANNER OF THEIR EXHIBITION. 



AN APPENDIX 



CONTAINS COMPARATIVE TABLES OF WEIGHTS AND MEASURES, AND AN 
EXCELLENT METHOD OF TESTING URINE. 



BY THEODORE STREHZ, M. 

BRIGHT ^ 

^ h |' 24 1890 C ;)' 

Chicago: IHb&ftV 

PUBLISHED BY THE AUTHOR/^ 
1889. 




Entered according to Act of Congress, 
In the Office of the Librarian of Congress, at Washington, D. C. 

IN THE YEAR 1889, BY THEODORE STREHZ. 



LC Control Number 




tmp96 028750 



TO 

DR. JOH. NEP. RITTER VON NUSSBAUM, 

PROFESSOR AT THE ROYAL UNIVERSITY OF MUNICH, GERMANY, 
SURGEON IN CHIEF OF THE ARMY, ETC., ETC., 
IN RECOGNITION 
OF HIS DISTINGUISHED ABILITY AS A SURGEON AND HIS NOTED 
LABORS IN THE FIELD OF MEDICAL SCIENCE, TO- 
GETHER WITH HIS PERSONAL AMIABILITY 
AS GENTLEMAN AND FRIEND, 
THE AUTHOR TAKES PLEASURE IN DEDICATING 

THIS VOLUME. 



PREFACE. 



In launching this book into the sea of medical life, the 
author is very well aware that it is not a full ship ; but among 
the smaller craft it is sure to take the rank of a trustworthy 
life-boat. As would be expected, the matter treated of in this 
work is neither new nor original; but the author claims for the 
form in which it has been pressed, not only originality, but real 
practical utility, and as it is expected to furnish to a large 
circle of the medical profession a veritable hand-book, "for 
reference, of service, in any case, whatever its nature may be," 
hopes that it will prove a true friend to many a practitioner into 
whose hands it should fall. To avoid a wrong interpretation of 
the above assertion it will be necessary to add, that "any given 
case" will have something of an analogon "of service" to the 
reflective physician. 

The therapeutical part, with an introductory paragraph on 
poisoning and other cases of emergency, which require prompt 
and energetic treatment, is presented in three divisions: Inter- 
nal, hypodermic, and external medication. The medicines for 
internal use are classified according to their physiological and 
therapeutical action in Chapter I, while the remedies for hypo- 
dermic medication (which form, after all, a part of them) are 
arranged alphabetically in Chapter II; and the topicals, with 
which are also classed electricity, hydropathic items, and those 
remedial agents used for inhalations, rectal, urethral, and 
vaginal medication— since they for the most part belong to the 
domain of surgery and collateral branches — are enumerated in 
Chapter III, under the heads of the various organs to which 
they are applied for curative purposes. The omission of many 
new, though perhaps important remedial agents, will be excused, 
because the reliability of the work must largely depend upon 

v. 



vi. Preface. 

the employment of drugs of known properties, and beyond the 
stage of experimentation. Part II. gives in concise form the 
essentials of the medical art, including Obstetrics, Gynaecology, 
Pediatrics, Neurology, Dermatology, and all those branches, 
which, being treated of in purely medical and surgical works 
but sparingly, if at all, represent that important part of sub- 
divisions which claim of late the special attention of thera- 
peutists. 

As by far the greater number of prescriptions are selected 
from standard works, though not authenticated by the names 
of their respective originators being attached to them, they may 
be used with perfect confidence; and the formulae, both of 
official and non-official compounds much in use, and to be pre- 
pared ex tempore, will be a welcome addition, especially to the 
country practitioner. The occasional dosage of these formulae 
and prescriptions, par excellence, in metric weight, is calculated 
to make him acqainted with a system which before long is sure 
to be adopted in the United States, as it is already in use in 
most European countries. Besides a table for converting one 
kind of weight into the other, the doses of all the remedies are 
given in apothecaries' weight, with its equivalent of the decimal 
system. 

I may mention that I have advisedly made an indiscriminate, 
though by no meaus exhaustive, use of the different names of 
one and the same remedy in the prescriptions for the purpose 
of bringing into full view the existing confusion, and if, with 
regard to t! e chemicalp, I have given a preference to the no- 
menclature employed in Germany, it has been on the ground that 
it is the one in conformity with the symbols used in works on 
chemistry, not only in that country but also here and in England. 

In conclusion I wish to say that the views held in this work 
are strictly in conformity with the teachings of authorities on 
the various subjects here and abroad — thus representing the 
present state of medical science — and I need scarcely add, that 
nobody will make me responsible for their correctness, as I am 
perfectly aware of their not infrequent collision with the opinions 
and theories of practitioners of undoubted ability. 

THEODORE STREHZ. 



CONTENTS. 



PART I. 
THERAPEUTICS. 

PAGE. 

Introductory— Drowning, Hanging, Strangula- 
tion, Asphyxia from breathing Noxious Gases, 
Poisoning, and other cases of emergency, which 
require prompt and energetic treatment, - - 1 



CHAPTER I. 
INTERNAL MEDICATION. 

Section 1.— Reconstructions, comprising Alter- 
atives, Antiperiodics, Antistrumous, Anti- 
syphilitics, Antiseptics, Antizymotics, etc., 
with notes relating to their physiological action 
and their therapeutic value, besides rules to be 
observed in their exhibition in certain diseases, 
etc. ^ 

Section 2. — Sedatives, including Anodynes, 
Narcotics, Antispasmodics, Hypnotics, Ances- 
thetics, etc. - 

Section 3.— Correctives and Eliminatives, com- 
prising Acids, Antacids, Expectorants, Dia- 
phoretics, Diuretics, etc. 

Section 4. — Astringents, etc. 

Section 5.— Restoratives, comprising Stimulants 
and Tonics, -..-"■" 

Section 6.— Cathartics, ---.-'- 

Section 7.— Emetics, " 

Section 8.— Vermifuge, ... - 102 



40 
59 

69 



CHAPTER II- 

HYPODERMIC MEDICATION, - - - 106 



vin. Contents. 

CHAPTER III. 

PAGE. 

EXTEENAL MEDICATION. 

1. For Eye and Ear Diseases, - - 111 

2. For the Air Passages and adjacent 

parts, including Inhalations, - - 115 

3. For Genitals of Man, - - - 122 

4. For Female Genitals and Womb Dis- 

eases proper, 124 

5. For the Rectum, including Enemata, 134 

6. For the Head, Face and Skin — 138 

a, Erysipelas, Neuralgia, Rheumatism 

and Eruptive Feveis. 
by Ulcers, Tumors and Skin Diseases 

proper. 

c, Affections from Heat and Cold. 

d, Bites and Stings of Insects, etc., and 

other Wounds. 
6, Hydropathic Items. 
f 9 Electricity. 



APPENDIX. 



1. Table of Weights and Measures (Metric 

and Apothecaries'), - - - 152 

2. Analysis of Urine, - - - - 154 



PART II. 



GENERAL NOSOCOMIUM CONSISTING 
IN AN ALPHABETICAL ARRANGE- 
MENT OF THE DISEASES, with their sev- 
eral definitions, symptoms (whenever possible 
pathognomic) and causes, together with diag- 
nostic hints, and the remedies usually em- 
ployed in their treatment, according to the 
present state of medical science, - - - 158 



PART I. 

THERAPEUTICS. 

Introductory — Drowning, Strangulation, Pois- 
oning and other cases of emergency which require 
prompt and energetic treatment. (For other cases of 
Asphyxia, Insolation, Poisoned wounds, etc., see part II). 

Asphyxia from Drowning — Let the head hang 
down for two seconds, that the water may run out of the 
month. Now lay down the body with the head raised, 
wipe out the mouth and throat, draw the tongue well 
forward and dry the face; then have the wet clothes 
stripped off and the rest of the body rubbed dry. If 
breathing has not quite ceased, the nose and fauces may 
be tickled to excite sneezing, coughing or vomiting, 
and the circulation and respiratory acts should be 
roused by brisk friction, occasionally dashing cold water 
on the face, neck and chest, and then wiping them dry with 
a warm towel. If these means fail, Artificial Respir- 
ation.* Warm spiced w r ine may be given, if the patient 
can swallow, if not, it maybe introduced into the stom- 
ach by means of a flexible catheter and syringe. Warm 

* Marshall Hall's Plan — Have the patient placed on his 
chest, with one wrist under the forehead; then roll the body 
over on the side far enough to remove the pressure of its 
weight on the thorax, to facilitate respiration; now, after two 
seconds, return it to its normal position, in which you leave it 
also for two or three seconds. In this prone position the expir- 
atory act may be increased by some pressure with the hands 
along the back. These movements of alternate compression 



2 Death From Hanging. 

enemata, with, salt and mustard, or of brandy and water, 
may be of service in the early stage, whilst the heart's 
action is faltering. One point is to be enforced: Treat 
the patient instantly on the spot, in the open air, freely 
exposing the face, neck and chest to the breeze, except 
in severe weather. 

Death from Hanging or Strangulation, which 
is usually induced by a mixed cause — suffocation and 
apoplexy (the latter, when the rope or strangling imple- 
ment has been applied so high on the neck, that the 
jugulars are more effectually compressed than the wind- 
pipe), seldom by dislocation of the neck, requires a 
similar treatment: dashing of cold water on chest and 
face; if the latter be turgid, bleeding from the jugular 
vein; and Artificial Respiration, (p. 1*). In cases not 
complicated with apoplexy, the diaphragm may be ex- 
cited by the passage of a galvanic current from the nape 
of the neck to the pit of the stomach. 

Asphyxia from Breathing Noxious Gases, is 
treated on the same principle: The body must be stripped 
at once, cold water dashed over the head and chest 
and Artificial Respiration, (p. 1*). Chest and limbs should 
be rubbed with stimulating embrocations, and electric 
shocks sent through chest and diaphragm may be tried. 

and expansion should be gently but perseveringly continued 
until natural respiration sets in, but no longer. 

By Pectoral Concussion— About fifteen consecutive move- 
ments are made with both fists, placed in the ileo-ooecal region, 
in the direction of the diaphragm and heart, followed each 
time by a few brisk slaps in rapid succession on the chest over 
the heart with the palm of the hand. The single movements 
must be performed with a certain vigor, as if the contents of 
the chest had to be forced out of the mouth. 

In all cases, before commencing artificial respiration^ 
clear the mouth and air passages from obstruction. 



Poisoning. 3 

Afterward the patient should be put in a warm bed 
and Stimulants given. 

Asphyxia from Lightning claims the same 
treatment: Stimulants internally and electricity are 
said to be here especially useful. 

Suspended Animation Induced by Intense Cold. 
— Here the body is first rubbed with snow or iced 
water, then with water of the usual temp., which is 
very gradually replaced by warmer water, when the 
patient is put to bed in a temperate room, where fric- 
tion with the warm hand should be continued for some 
time. (The same procedure is indicated if only part 
of the body is affected, because the sudden application 
of heat would be sure to cause mortification.) Volatile 
Essences applied to the nose; Stimulants internally or by 
injection; and, if necessary, Inflation of the lungs. 

Antidotes* to Anorganic Poisons. — Green of Paris 
and other arsenical preparations : The principal anti- 
dote is freshly prepared Hydrated Sesquioxide of Iron, 
given in large quantities (p. 80). Besides milk gruel, 
Albumen (156); Magnes. (112); Aq. Calcis, etc. 

Mercury and its Salts: Albumen in the shape of the 
white of eggs (156). Catechu as infusion (p. 63); flour 

* General Treatment of Poisoning. — In addition to the 
treatment of Gastritis, which is always caused by acrid and 
corrosive poison*, the evacuation and neutralization of the 
poisonous substance claim primary attention. Emetics (pp. 100 
and 101) are to be promptly given, and, if they fail, the stomach- 
pump (297) must be resorted to, provided the poison be one 
which can be ejected. After having the stomach evacuated, the 
required antidote may be given, followed, if necessary, by Ca- 
thartics and Diuretics. In poisoning with corrosive acids 
the necessary antidote has to be given at once, and the vegetable 
irritants, as Aloes, Elaterium, Jalap, Croton,etc, require after 
the emetic warm and copious Demulcents, with Cordials or 
Narcotics, according to circumstances. Drowsiness or insensi- 



4 Poisoning. 

and water, followed by an Emetic (p. 100). The stom- 
ach-pump. In chronic poisoning {Salivation) : Pot. chlor. 
or Pot. jod. (298 & 300) as gargle. 

Verdigris and other Copper preparations : Albumen 
(156); Pot. cyanat. (66); Milk; Tea. Infusion of Oak- 
bark, etc. (no acids). 

White Vitriol and other Zinc preparations : Albumen 
(156); Soda (p. 55); Tannin (p. 62); Milk; OakbarJc. 
If vomiting, plenty of warm waxer. 

Nitrate of Silver: Table salt in solution freely. 

Lead and its Salts: Magnes sulf. (p. 95); Sod. 
phosph. (p. 97); Acid, sulfuric, (p. 61); Alumen (p. 63). 
To relieve pain and spasms: Opium (p. 35). In the 
chronic form: Iodine (p. 15); Strychnine (p. 83). 

Tartar Emetic: Tannin (p. 62); Tea; Oakbark, etc. 
Besides Stimulants. 

Mineral Acids : Alkaline Carbonates or Soap; Plas- 
ter from the wall with milk or water; Chalk; Magnesia 
(112). In Sulfuric acid poisoning : Plaster or Soap 
without water, afterward flaxseed tea. In Oxalic acid 
poisoning: Chalk or Magnes. but no Alkalies. In Car- 
bolic acid poisoning : Soap or Magnesia; Sod. sulf. or 

bility as a consequence of narcotic poisoning may be treated 
with strong hot coffee, after the stomach has been evacuated 
by means of Purgatives, or Apomorph. hypod. (p. 107), or some 
other emetic; and if syncope or paralysis of the respiratory 
movements have been induced by the poison, Stimulants must 
be given to counteract the former, whilst the latter may be 
treated with cold affusions, irritation of the skin, artificial 
respiration, excitation of the Pneumogastric by Atropia, 
etc., etc. 

As the Antidotes act either chemically, by destroying the 
properties of the poison, or physiologically by their antagonistic 
power, it is of vital importance to arrive as soon as possible at 
a correct diagnosis. 



Poisoning. 5 

Sulf. acid. (p. 16); Sacch. Calcium in strong solution. In 
Bichrom. acid, poisoning : Chalk or Magnesia with milk. 

Ammonia and Alkalies: Vinegar and Vegetable 
acids; Oil and Demulcents. 

Alcohol: Strong Coffee; Cold douche; Ammon. (p. 
43); Salt (p. 101); Brom. (p. 25); Cocaine (pp. 77 & 109). 

Bronx.: Amylum; Magnesia (112); Ammonia (p.43). 

Chloral: Counter-irritants, Cardiac Stimulants and 
maintaining the bodily heat (as in Opium). 

Chlorine : Album. (1 5 6) ; Magnes.( 1 1 2) ; Mucilag. drinks. 

Chloroform : Head low and feet elevated; Inhalation 
of Ammonia (316); Cold water to chest and ice to rec- 
tum. Brandy hypoderm.; Artificial Respiration (p. 1*). 

Creosot.: Albumen (156). 

Iodine: Amylum; flour and water; afterward vine- 
gar and water; and mucilaginous drinks. 

Phosphor.: Magnesia (112); Terebinthina (150). 

Antidotes (p. 3*) to Organic Poisons. — Aconite: 
Warmth, friction and veget. Astringents (p. 62); Opium 
(p. 35); Digital, (p. 78), to support the heart's action. 

Belladonna: Vegetable Astringents (p. 62); Morph. 
hypoderm. in small and repeated doses (p. 110); Jabor- 
andi (109); Apomorphine (p. 107). 

Calabar: Atropin (pp. 23 and 108), to antagonize the 
respiratory depression. Artificial Respiration (p. 1*). 

Cannabis like Opium. 

Cantharis: Opium (p. 35); Camphor, (p. 28); De- 
mulcents and warm bath. 

Colchicum Coffee; Tannin (p. 62); Demulcents and 
Stimulants. Digitalis (p. 78); Opium (pp. 35 & 48). 

Conium: Stimulants; Atrop. (pp.23 &108); Strychnin 
(p.83); Opium(pp. 35 & 110); Artif. Respiration (p. 1*). 



6 Poisoning. 

Cyan. (Aq. laurocerasi — 01. Amygd. am, etc.): Cu- 
prum (p.100); Ferrum(143); Ammonia (p. 43). Cold 
douche and Artificial Respiration (p. 1*). 

Digitalis: Horizontal position; Tea; Coffee; Stimu- 
lants; Tannin (p. 62); Albumen (156); Opium (p. 35). 

Ergot: Brandy and Demulcents with hot applica- 
tions to body. Digitalis (p. 78). 

Gelsemin: Brandy; Ammon. (p. 44); Digital, (p. 78); 
Bellad. (pp. 23 & 108); Artificial Respiration (p. 1*). 

Hyoscyamus like Belladonna. 

Lobelia: Brandy; Counter-irritation; Tannin, (p. 62); 
Anodynes (p. 20). 

Opium: Continuous motion; strong Coffee or Tea; 
cold Douche; Emetic (p. 101); Caffein (163); Tannin 
(p. 62); Cocaine (pp. 77 & 109); Bellad. (pp. 23 & 
108;; Digitalis (p. 78); Artificial Respiration (p. 1*). 

Santonin: Emetics and Laxatives (p. 104); Chloro- 
form (pp. 30 & 109). 

Strychnin: Coffee; Tea; Brandy (p. 73); Tannin 
(p. 62); Brom. (p. 27); Chloral (p. 30); Calabar (270); In- 
halations of Chlorof . or Amyl. (304 & 308). Inf us.Chamom. 
p. os et p. anum; Tobacco-enema. Artif. Respir. (p. 1*). 

labaccum: Brandy (p. 72); Opium (p. 35); Digital, 
(p. 78); Strychnin (p. 83). Inhalation of Ammonia 
and Artificial Respiration (p. 1*). 

Veratrum viride: Brandy by mouth and rectum (p. 
72); Ammonia (p. 43); Opium (p. 35); friction to body. 

Animal Poison (Snake-bite, etc.): Cauterization of 
wound with Arg. nitr. or Nitr. Acid (329). Alcoholic 
Stimulants (p. 72); Ammon. (p. 43); Cedron (p. 10). 



SECTION I. 

EECONSTEUCTIVES. 

They comprise Alteratives, Antiperiodics, Anti- 
strumouSj Axtisyphilitics, Antiseptics, Antizymot- 
ics, in fact, all those medicines which have a decided 
effect on certain cachectic conditions of the blood, and 
through either their destructive or reconstructive power 
assist the vis medicatrix naturce in her efforts to repro- 
duce the natural state of the various constituents of the 
human body. 

Acid, nitric, d: Alterative, Antilithic. 

Arsenic: Alterative Antiperiodic, Anticonvulsive, 
Nerve Tonic. 

Aurum: Antiscrofulous, Antisyphilitic. 

Baptisia: Antiseptic, Cathartic. 

Barium : Antiscrofulous, Anthelmintic. 

Cedron: Antiperiodic. 

Chinin. : Antiperiodic, Antiseptic, Antispasmodic, 
Antineuralgic, Antipyretic, Tonic. 

Chrom. : Antiseptic. 

Fucus : Alterative. 

Guayacum: Alterative, Diaphoretic, Stimulant. 

Hydrargyrum: Alterative, Antisyphilitic, Antiphlo- 
gistic, Cholagogue, Sialogogue, Cathartic. 

Iodum: Alterative, Antiscrofulous, Antisyphilitic. 

Naphthalin: Antiseptic. 

Phenol : Antiseptic. 

1 



Hecons tructives. 

Pulsatilla: Alterative, Emmenagogue. 
Resorcin: Antiseptic, Antipyretic, Haemostatic. 
Salicin: Antiperiodic, Antizymotic, Antiarthritic. 
Sarsaparilla: Alterative, Diuretic. 
Silicia: Antiarthritic. 
Sulfides : Antisuppurati ve. 
Sulfites: Antizymotic. 
Thymol : Antiseptic. 



Antiperiodics, Antiseptics, etc. 



1. 
5 Acidi nitric] d. 3 j. 

Dec. Saiza* Oj. 
To be taken during one or 



2b. 
I> Liq. arsenic. Donov. 3 ij. 
Gtt. x ter die p. cibum. 

Tumor within Brain. 



two days. Syphilis. 


2c. 


2a. 


I£ Sol. arsenic. Fowl. 3 ij. 


5 Arsenici iod. 0.2. 


Gtt. v. ter die p. cibum. 


Extr. Conii 2.5. 


Gastralgia. 


F. pilula3 35, ut singula? 


3a. 


contineant 0.005 7. 


IJ Auri et Sod. Chlor. gr. j. 


j ter die p. cibum. 


Argilla? 3ij. 


Gout (rheumatic). 


Divide in 20 p. nequales. 


Gutan. Erupt. 


j ter die. Spermatorrhoea. 


Acidum nitricum dil.: gtt. 


2—20 = 0.15 —1.5. 


Arsenicum album: gr. 


1.40—1.8 = 0.0015—0.008. 


11 iod.: gr. 


1-20—1-5 = 0.003 —0.012. 


" Sol. Don.: gtt. 


3—15 = 0.2 —1.0. 


" " Fowl.: gtt. 


2—10 = 0.12 —0.6. 


Auri et Sodii Chlor. : gr. 


1-20—1-10= 0.003 —0.006. 



Acid, nitric, dilutum is also used in Physometra. Gtt- 
viij — x sextis horis in Intermittens. See sections in & v. 

Arsenic must never be given on an empty stomach, 
and it must be stopped when there is itching of the con- 
junctiva. Its specific effects aside from the itching are: 
(Edema and stiffness of the eyelids and face, tenderness 
of mouth, itching of the skin and uneasiness about the 
stomach. It is frequently used in Chronic Eczema, 
Lichen, and the scaly diseases — Lupus, Lepra, Psoriasis; 
and in some skin diseases it is valuable for subduing 
pain. It is also used in Chronic Bronchitis, Cystic 
Goitre, Chorea, and Vomiting of Drunkards. 

In Rheumatic Gout it is said to be superior to any 
other remedy, and in conjunction with Tannin it is pref- 
erable to Quinine. The average dose isgr. 1-10 ter die; 
gr. 1-20 ter die in Cancer or Irritable Uterus. 



10 RECONSTRUCTIVE 8: Alteratives. 

3b. 5a. 

5 Auri et Sod. Chlor. 0.1. ^ Barii Chloridi 

Aquae destillatae 50.0. Extr. Conii ^ 2.0. 

Gtt. xx. ter die. Syphilis. Vini stibiat. 5.0. 

(secondary) Aq. destillatae 20.0. 

(To increase to 50.) Gtt. xx— xxx tertiis horis. 

4. Orchitis {chronic). 

r> Tr. Baptisiae Rd. 5b. 

" Gentian.comp.^ 3ij. 1J Barii chlorati 2.0. 

Glycerini § ss. Aq. destillatae 30.0. 

Gtt. v — xx omni hora. Gtt, v— x semel vel bis die. 

Typhus. (2 to 3 years.) Scrofula. 

4b. 6. 

IJ Tr. Baptisiae 3 ij. 5 Cedrcn. Simab. 

Elix. simp], ad | ij. Con. Cinchonae T 0.5. 

3 j hourly. Scarlatina. During cold stage. 

(malignant. ) Intermittens. 

BaptisiaTr.: gtt. 20—60 = 0.65—2.0. 
Barii Chloridum: gr. 3 — 10 = 0.20 — 0.65. 

Fowler's Solution: gtt. v — x ter die in Intermittens. 
Arsen. chlor o-phosph. : gtt. xv — xx ter die post cibum in 
Sexual Weakness, Nervous Exhaustion, Loss of Memory, 
or Threatening Insanity. 

Cigarettes made of paper, saturated with a strong 
solution of Sod. arsen. are smoked in Asthma. 

Donovan's Solution: Arsen. iod. 

Hydr. biiod. aTgr. xxxv, Aq. § viij. 

Auri et Sod. Chlor. is similar in its effects to Sublimate, 
but is most used in premature decline of sexual powers; 
and in Locomotor Ataxia, early and persistently exhib- 
ited, it will arrest the disease(?) — As sugar and other 
organic substances reduce the gold, the salt should be 
given in Aqua destillata, or as pill with Argilla. 

Baptisia is sometimes given in Diphtheria and in 
putrid ulceration of the buccal mucous membrane. 

Cedron is with the inhabitants of Dutch Guiana a 
popular antidote for snake bite. Dose, gr. j — ij. 



Antiperiodics, Antiseptics, etc. 11 

7a. 7c. 

IJ Chinini Sulfatis IJ Chin, sulfurici 

Acid. sulf. d. 7 3 ss. Extr. Gentiana?, ? 3 j. 

Syr. Aurant. C. 3 ij. F. piluloe 24. 

Aq. font. 3 jv. j vel ij quartis horis. 

3 j omni hora. Pneumonitis (Until cinchonism; and to 
{abortive.) begin, if possible, in the 
7b. sweating stage. ) Intermittens 

g, Chinini sulf. 3 ss. 8. 

Tr. Ferri chljr. 3 ijas. IJ Cinchonid. tannici 1.0. 

Aquae footana* 3 v. Syrupi Rhei 40.0. 

3 ss quartis horis. 3 j bihorio vel tertiis horis. 

(The first dose may be Teething. 

doubled.) Septicemia. (with constipation^) 

Chin. Sulfas: gr. 1—40 = 0.065—2.6. 
Cinchonid.: gr. 3 — 30 = 0.2 — 2.0. 

Quinine has a marked influence on pulse and temper- 
ature, lessening at the same time the amount of uric 
acid and urea in the urine. Taken for some time, or in 
large doses, it produces Cinchonism — tinnitus aurium, 
with partial deafness, coupled with severe headache; 
sometimes dimness of sight, (suffused eyes and dilated 
pupils) with flushed face; and not unfrequently de- 
lirium, even convulsions may supervene. In In- 
termittens and other fevers of malarial origin, it is 
the remedy, p> ar excellence. In pernicious Intermittens 
3j every 3 hours unless Cinchonism; per rectum 
the dose may be larger. In the varieties of Typhus, 
especially that termed Cerebro-Spinal Meningitis, it is 
given in similar doses, in conjunction with alcoholic 
stimulants. A 3j dose in Bronchitis is said to be 
abortive, and from ±)i to 3ij may be given in Typhoid 
before the evening exacerbation. It is contra-indicated 
during menstruation, as it may produce hypogastric pnin. 
See section v. 

Cinchonid. tann. 0.1 — 0.3 every hour or half hour in 
febrile diseases and Cholera Infantum; and in weak 
children, with worms, it is very valuable. See sec. viii. 



12 HECONSTRUCTIVES: Alteratives. 

9. 12a. 

g, Pot. Chromatis 0.1. r> Calomel, gr. xxj v. 

vel Bichrom. 0.01. Opii gr. jv. 

Aq. dest. 40.0. F. pil. 12. 

3 j ter die Syphilis, j bis die until ptyalism; then 

(secondary.} every-other-night one. 
10. Chancre. 

1$ Extr. Fuci vesiculosi Vel: 

Elix. simpl. 7 1 j. fy Mass. Hydrargyri 3 ss. 

3 ij ter die. Adipositas. Opii gr. jv. 

11 F. pilules 16. Same. 

]J, Tr. Guayaci ammon. Vel: 

Tr. Cinchonae 'a 1 j. % Hydr. iod. fl. gr. vj. 

3 ij bis die e cyatho lactis. Extr. Conii 3j — ij. 

Rheumatism (chronic.) F. pilulse 24. Same. 

Chrom.Pot.: gr. 1-6 —5-6 = 0.01 — 0.05 ter die. 
Bichrom. " gr. 1-12— 1-4 = 0.005— 0.015 " 
Fucus, Extr. fl.: 3 j — 3 = 4.0 —12.0. 

Guayac.Tr.amm.: 3 ss — 2 = 2.0 — 8.0. 
Calomel: gr. 1-6 —2 = 0.01 — 0.13. 

Hydrarg. Massa. : gr.l — 15 = 0.065 — 1.0 

_ a 

Chrom. As organic substances reduce chromic acid, 
the salt must be dissolved in Aq. dest., or mixed with 
Argilla as pill. Pot. bichrom. in doses of 0.05 is sure 
to produce Gastro-enteritis, and may even cause death ! 

Fucus requires the following diet: Roast meat, fish, 
fruit and vegetables; but no potatoes and other farina- 
ceous articles. (Bread, sparingly, and either stale or 
toasted.) Tea and coffee without milk and sugar, a 
little wine and Succus Citri to quench the thirst. 

Guayacum is also used in Syphilis; occasionally in 
Amenorrhoea and Dysmenorrhoea. 

Mercury (see Iodine) has to be suspended or stopped 
altogether as soon as salivation sets in. The latter is 
soonest produced by Blue Pill; Calomel comes next 
Calomel in larger than 2 gr. doses acts as a purgative. 
See sec. vi. Hydr. c. Creta, gr. 1 ter die is recommended 



Antiperiodics, Antiseptics, etc. 13 

12b. 14c. 

fy Calomel, gr.j. 5 Hydr. bichlor. gr.f . 

Opii, gr. | to £. Pot. iod. $]. 

Tertiis vel quartis horis. Tr. Cinchonae 

Dysentery. Tr. Rhei ^ § ss. 
13. Gtt. xxx ex aqua bis die: 

IJ Hydr. c. Creta gr. ij. (6 years). 1 yearrgtt. x. 

Every third night, followed Vaginal Discharge. 

in the morning by salts 3 j. (fro?n Scrofula.) 

Jaundice. 
14a. 14d. 

5 Hydrarg. bichlor. t> Hydr. Bichloridi gr.j. 

Ammon. chlor. ^ gr.j. Pot. Iodidi T)ij. 

Micae Panis, q. s. Extr. Cinchon. fl. § ss. 

F. pilulae 12. vel Syr. Ferri iod. § j. 

j ter die post cibum. Aq. fontanae ad § viij. 

Tumor within Drain. § ss ter die ex aqua. 

Chancre. 

14b. 15. 

r> Hydr. bichlor. gr.j. r> Hydrarg. biiodati 0.1. 

Tr. Ferri chlor. 3 ss. Pot. iodati 8.0. 

Extr. Fuci mar. fl. 3 jss. Pot. bicarb. 3.0. 

3 j ter die ex aqua. Decocti Sarzae 180.0. 

Pharyngitis. § ss ter die. Syphilis. 

{syphilitic.) [secondary and tertiary.) 

Hydr. Bichlor.: gr. 1-32—1-8 = 0.002—0.008. 

Hydr. Iod. rbr.: gr. 1-32— £ = 0.002—0.008. 

Hydr. Iod. v.: gr. 1-6 —2 = 0.01 —0.13. 

Hydr. c. Creta: gr. 1—12 = 0.065—0.8. 

as preventive of secondary Syphilis; 0.02 ter die will 
relieve the swelling in Parotitis. (?) 

Hydr. Dichloridum (Hydrargyrum bichloratum) gr. 
1-60 — 1-30 ter die ante cibum in Gastric Ulcer; and in 
chron. Diarrhoea this dose may be gradually increased. 
Hydrarg. Iodidum rbr. (biiodatum No. 15) in syphi- 
litic Iritis and Pharyngitis. Hydrargyrum iodatum 
flavuni is the protoioduret. 



14 RJBCON STBVGTIVES: Alteratives. 

16a. 18. 

5 Pot. Iodidi 3ij. 5 Pot. iod. 3 j. 

Inf. Quassiae § jv. Tr. Cinchonae § ss. 

| j bis die. Syphilis. Aq. font, ad § vj. 

{secondary.) § ss ter die. Pharyngitis. 
16b. Vel : 

r> Pot. iod. 3 j. 5 Pot. Iodidi 

Extr. Xantoxyl. fl. 3 ij. Pot. Bromidi 
Aq. Fontis | vj. Amnion. Chloridi -j 3j. 

| ss. ter die. Rheumatism. Aq. destillatae § vj. 

(chronic.) 19 a. 

( TF%A cedemat. extremities.) rj Kalii iodati 3 iij. 

Syr. Ferri iodati f ij. 
17a. Tr. Colombo § vj. 

^ Kalii iodati 5.0. 3 ij ter die ex aqua. 

Natri biearbonici 1.0. Chronic Peritonitis. 

Aquae fontanae 400.0. [pelvic.) 

| ss bis die. Pimples. 19b. 

(of young people.) rj Pot. iodati 8.0 

17b. Aq. destillatae. 50.0. 

IJ, Pot. iod. gr. ij. Ferri sulfurici 6.0. 

Pot. bicarb, gr. v. Post agitationem admisce: 

Extr. Sarz. fl. 3j. Tr. Cardam. comp. 

vel Ext. Cinchon. fl. gtt. viij. Syrupi simpl. 'J 25.0. 

Aq. fontanae § j. 3 j ter die. Amenorrhoea. 

3 jbis die. Scrofula, (with headache and pains in 

(1 year.) pelvis.) 

Iod. Pot.: gr. 3—30 ===== 0.2 — 2.0. 
Iod. Ferr. Syr.: gtt. 15—45 == 1.0—3.0. 
(5ij - 1.5.) 

Iodine. Pot. iod. must not be given with narcotic 
alkalies, metal salts, acids and Aq. Amygdal. am. Its 
use has to be stopped for 5 — 10 days if there appear 
inflammatory eruptions of the skin. If in use, Calomel, 
even externally, must not be employed, as Hydr. iod. 
may form, nor Pot. chlor. or Syr. Ferr. iod. must be 
used, as Iodine may separate and produce intoxication. 



Antiperiodics, Antiseptics, etc. 



15 



20a. 
3 Iodi 2.0 

Pot. Iodidi 10.0 

Aq. destillatre 250.0 

3 ijterdie ante cibum ex vino 

rubro vel aqua. Paraplegia. 

20b. 
IJ Iodi 1.5. 

Pot. iodati 3.0. 

Aquae destillataa 30.0. 
Gtt. v — xxx ter die ex aqua 

saccharata. 

{Liq. iodatus Lugol.) 
20c. 
5 Iodi 1.0. 

Solve leni calore in 

Glycerini 100.0. 



20d. 
5 Iodi 0.2. 

Alcoholis 2.0. 

Glycerini 200.0. 

1 j — j g s per diem. 
Substitute of Ol. Jecoris. 
21. 
IJ Naphthol. (Beta) 
Bism. salicylici • 
Magn. carbon. ^ 0.3. 
This dose quartis horis. 
Furuncles. 
22a. 
5 Liq. antisept. P. 25.0. 
Tr. Catechu 15.0. 

Syr. simplicis 150.0. 
3 ij semis horis. Cholera. 



Iodum: gr. \ — 1 

IodiTr.: gtt.2— 10 
Naphthalin.igr. 2 — 8 
Phenol: gtt..i— 3 



0.015—0.065. 
0.065—0.32. 
0.13 —0.5. 
0.032—0.2. 



Iodism is characterized by Eruptions of Skin, Laryn- 
gitis, Intestinal Catarrh, Vertigo, Fainting, etc. 

Pot. iod. gr. 15 — 3 j p. diem, if it be borne, in Lead 
Colic; gr. 5 — 10 quater die in Cellulitis and second stage 
"of acute Cerebral Meningitis. Syr. Ferri iodati gtt. xxx 
ter die in Scrofulaand Chlorosis. Forchildren: gtt. 15bis 
die (4 years); gtt. 6 — 10 ter die (2 years). In convulsions 
from loss of blood it is sometimes very valuable. 

Tr. Iodi gtt. v ter die in Retention of Menses. In gtt. j 
doses it is said to check the vomiting in cholera; and t. die 
with Laudan. gtt. ij it is recommended as prophylactic. 

Iodine is also used in Fibroid, LTterine Cancer, Ovar- 
ian Dropsy, Bronchocele, Ringworm, etc. 

Naptholin is a good antifermentative and germicide, 
and therefore recommended in intestinal disorders; 
it has been given as much as 3 j per diem. Naphthol 
2,5 p. diem in Typhoid. 



16 BEGONSTJRUCTIVES: Alteratives. 



22b. 


23b. 


5 Acidi carbolic! 5.0. 


^ Extr. Pulsat. fl. 3 ss. 


Glycerolati Arayli 10.0. 


Aq. Menthae § jss. 


Radicis Calami 5.0. 


3 j bihorio. Hysteria. 


Rad. Althseae q. s. 


24. 


TJt fiant pilulae 200. (quarum 


5 Resorcini 1.0 — 2.0. 


singulae contineant 0.025). 


Aq. destill. 100.0. 


j quater die. Pruritus. 


Syr. Aurant. Cort. 30.0. 


(To increase to 3 daily.) 


| ss bihorio. Intermittens. 


23a. 


25. 


5 Hb. Pulsatilla 


5 Salicini 


Extr. Pulsatilla T 5.0. 


Pepsini 'J 1.0. 


01. Menthae pip. gtt. j. 


Glycerini 40.0. 


F. pilulae 75. 


Leni calore solutio efficiat. 


j vel ij ter die. Amaurosis. 


3 j ante cibum. Dyspepsia. 


Pulsat. Extr. h\: gtt. 


2— 6 = 0.065—0.2. 


Pulsat. Tr.: gtt. 


30—60 = 1.0. —2.0. 


Salicin: gr. 


3—60 = 0.2. —4.0. 



Phenol is said to be excellent in tapeworm. (See 
section vm). Sod. sulfo-carbolic. 3j with Syrup bihorio 
in Variola. Intoxication from repeated Carbol. applica- 
tions may be treated with Sod. sulf., vel Acidum sulf. 
dilutum: Sulfo-carbolic acid is formed, and the dark 
color of the urine soon disappears. 

Liq. antisepticus Pernes: Acid, carbol. 10.0. 

Aqua. dest. 300.0. 
Mixtis instilla. Bromi. 5.0. 

Pulsatilla is also employed in skin diseases, catarrhal 
affections of nares, fauces and larynx, urinary passages 
and intestines. 

Pesorcin is equal to Quinine as antipyreticum, but by 
no means as tonic; to Phenol it is equal as antiseptic. 
The latter is a monhydroxylbenzol, whilst Resorcin is 
a dihydroxylbenzol. 

Salicin has not the disagreeable effects of Acidum sali- 
cylicum; and Sod. salicyl. is also milder than the acid, and 
therefore preferable; moreover, as it is decomposed by 



AntiperiodicSy Antiseptics, etc. 



17 



26a. 
IJ Acidi salicylici 5.0. 

Spir. Vini Gallic! 

Vini Hispanici 7 100.0. 

Syr. Aurant. Cort. 50.0. 

3 j bihoriovel quartis horis. 

Vel: Diarrhea. 

IJ Acidi salicylici 10.0. 

Liq. Amra. acet. 60.0. 

Aq. destillatae 230.0. 

3 j omni bora. 

26b. 
IJ Acid, salicyl. 

Sod. bicarb. 7 3 ss. 

Spir. Vini Gall. 3 ij. 

Glycerini 3 vj. 

Aq. font, ad 3 ij. 
3 ij omni hora. Same. 

( 4 years.) 
Vel: 
3 Acid, salicyl. gr. xij. 

Cretae praep. gr. viij. 
Divide in 10 vel 6 partes. 
j every 2 or 4 hours. 
( 2 months to 3 years.) 



27. 
rj Acidi salicylici 5.0. 
Sod. phosph. 13.0. 

Liq. Amm. caust. 2.0. 
Glycerini 

Aq. fontanae ? 10.0. 
H.somnisumenda.7 7 y/>/ms. 

28. 
rj Acidi salicylici gr. x. 

Natri salicylici gr. xv. 
Ter die. Rheumatism. 

{cirtic. acute.) 
29a. 
IJ, Sod. Salicylatis 

Sacchari ^ 1.0. 

Tales doses 5. 
j ex aqua. Migraine. 

29b. 
t> Sod. Salicylatis 6.0. 
Sod. Bicarbonatis 2.0. 
Glycerini 

Aquae fontanae £ 25.0. 
The whole at once, or in 2 
doses within -J- hour. 

Typhus. 



Salicyl. Acid. 


gr. 6 — 6-0 = 


= 0.4 —4.0. 


Salicyl. Sod.: 


gr. 10—20 = 


= 0.65—2.6. 



Carbonic acid, the acid is liberated in the stomach. As 
antipyreticum, Salicin is inferior to Nitre, and in heart 
and kidney diseases, it is moreover contra-indicated. In 
intestinal disorders, which are due to fermentation and 
putrefaction in the alimentary canal, Sod. salicyl., espe- 
cially combined with Bismuth, has been lately much 
employed. Treble the quantity of Acid, salicylicum will 
rep' ace Acidum earbolicnm? 

Salicylismus. Tinnitus, Vertigo, Vomiting, Deafness, 
General Malaise, Urticaria, Petechia?, etc. 

8 dicin. 0.3 — 1.5 bihorio vel tert, horis ante cibum 



REG ON STRUCT IVES: Alteratives. 



29c. 


31. 


IjL Sodii Salicylates 


tj Dec. Sarzae comp. § iij. 


Sodii Bicarbonatis 


Liq. Potassae 3 ss. 


Tr. Cannab. Ind. T 3 j. 


| ss bis die. Scrofula. 


Ext. Rhei fl. 3 iij. 


(3 years.) Atrophy. 


Elix. simplicis | j. 


32. 


Aq. Fontis ad § iij. 


IJ, Acidi silicici. 0.05 — 0.1. 


| ss bihorio. Cephalalgia, 


Sacchari Lactis. 0.05. 


[periodic.) 


Tales doses 12. Diabetes. 


(with cons tip. and languor). 


j ter die. 


30. 


33a. 


IJ, Natri boro-salicyl. 


IJ, Calcis sulfuratse 


Spir. Vini Gall, a 10.0. 


Gr. j bihorio. Boils , etc. 


Vini albi 150.0. 


Vel: 


Glycerini 40.0. 


R Sodii Sulfitis gr.x — xx. 


| ss bihorio vel tertiis horis. 


Tales doses No. 10. 


Gout, etc. 


j ter die. Thrush. 


Sarzae co. Extr. fl. : gtt. 15—60 = 1.0 — 4.0. 


Sulfid. Calcis: gr. ^—5 = 0.008—0.32. 



ex aqua in Catarrh and Diarrhoea; bis vel ter die as 
tonic. 2.0—4.0 during intermission in Intermittens. 
2.5 — 6.0 in Typhus and Parametritis. Sod. and Acid, 
salicyl. (No. 28) in Neuralgia, Lumbago and Ischias. 
Sod. salicyl. 0.5 ter die in Polyuria. 0.5 — 2.0 omni 
hora vel bihorio: antipyretic. 1.0 quater die: anaphro- 
disiac. 3.0 — 6.0 ter die in Hectic Fever. 5.0 — -8.0 p. 
diem in Arthritis nodosa. 

Sod. salicyl. 5.0 — Acid, salicyl. 4.1. 
Sod. bicarbon. 2.5. 

Sod. boro-salicyl.: Borac. 20.0; Sod. bicarb. 9.0; 
Acid, salicyl. 55.0. 

(Acid, salicyl. combined with Acidum boricum has a 
bitter taste, though neither acid in itself is bitter). 

Acidum silicicum. is frequently used in Chronic Rheu- 
matism, and sometimes in Carcinoma. 

Sulfides (N. 33 a ) prevent or arrest suppuration. The 



Antiperiodics, Antiseptics, etc. 



10 



33b. 


34 a. 


5 Sodii Sulfitis 3j — 3 ss. 


r> Acidi thymici gr. v. 


Bihorio vel tert. horis. 


Spir. Vini Gall. § jv. 


(In caps, amy lac.) Sarcind. 


Glycerini 3 ij. 


( Vomiting.) 


3 ij vel 3 ss bihorio. 


Vel: 


Scarlatina. 


5 Sodii Bisulfitis 3j. 


34b. 


Glycerin i 


IJ Thymoli 0.5. 


Aq. Fontis T 3 j. 


Kali chlorici 5.0. 


3 ii bis vel ter die. 


Chin, sulfurici 3.0. 


33c. 


Glycerini 80.0. 


IJ Sod. hyposulf. 10.0. 


Spir. Vini Gallici 250.0. 


Aq. destillatae 50.0. 


Acid, hydrochl. d. 1.0. 


Syrupi simplicis 100.0. 


3 j omni hora. Diphtheria. 


3 j ter die. Skin Diseases. 


(2 — 5 years.) 


Sulfis and Hypos. Sod.: 


gr. 3—20 = 0.2—1.3. 



same may be said of the Sulfites and Hy po sulfites ; they 
avert putrefaction and suppuration. (Sodii Hyposulfis — 
Natrum subsulfurosum — is soluble in 01. Terebinthinae 
and deodorizes it almost wholly). 

Acidum thymicum is similar to Phenol, but milder. Its 
depressing effect must be counteracted by the adminis- 
tration of Stimulants. See section viii. 



SECTION II. 



SEDATIVES. 



They include Anodynes, Antispasmodics, Narcot- 
ics, Hypnotics, Anaesthetics, etc. They have an 
exalting or depressing influence on the nervous system, 
thereby relieving pain, producing sleep, or causing 
insensibility, without affecting the structure of the 
nerve fibre. 

Aconite: Sedative, Anodyne, Antiphlogistic, Dia- 
phoretic, Diuretic. 
JEther: Sedative, Antispasmodic, Anaesthetic, Stimu- 
lant, Inebriant. 
Amyl: Antispasmodic, Anaesthetic. 
Anilin : Antispasmodic. 
Antimony: Sedative, Antiphlogistic, Alterative, 

Expectorant, Emetic. 
Asa fcetida: Antispasmodic, Diffuse Stimulant, Ex- 
pectorant. 
Belladonna: Antispasmodic, Cardiac Tonic, Diu- 
retic, Deliriant. 
Bromum: Antispasmodic. 
Camphora: Antispasmodic, Sedative, Diaphoretic, 

Expectorant, Stimulant. 
Cannabis: Anodyne, Antispasmodic, Antineuralgic, 

Hypnotic. 
Castoreum: Antispasmodic, Stimulant. 



Sedatives. 21 

Cerium: Nerve Tonic. 

Chloral: Antispasmodic, Sedative, Hypnotic. 

Chloroform: Antispasmodic, Anaesthetic, Anti- 
emetic. 

Coccus: Antispasmodic, Anodyne. 

Cokium: Antispasmodic, Sedative, Anodyne. 

Curare: Sedative. 

Cyan.: Sedative, Antispasmodic, 

Cypripedium: Sedative (like Valeriana). 

Dioscorea: Antispasmodic, Alterative, 

Dunoisix: Antispasmodic (like Belladonna), 

Gelsemium: Sedative. 

Grindelia: Antispasmodic. 

Hyoscyamus: Antispasmodic, Sedative, Hypnotic, 
Deliriant. 

Lactucarium: Antispasmodic, Sedative, Hypnotic, 
Diuretic, Laxative. 

Lycopodium: Antispasmodic, Diuretic, Aphrodisiac. 

Opium: Antispasmodic, Sedative, Diaphoretic, Diu- 
retic, Soporific. 

Ruta: Antispasmodic, Emmenagogue, Stimulant, 

Valeriana: Antispasmodic, Sedative. 

Vanilin: Antispasmodic (like Moschus). 

Veratrum viride: Sedative. 

Viburnum prunifol: Sedative (uterine). 

Xanthium: Sedative. 



22 



SEDATIVES: Anodynes, 



35a. 
fy Extr. Aconiti gr, jv, 

Extr. Papaveris gr, xij. 
F/pilulae 4, 

j omni hora. Neuralgia, 

with a soothing rubefacient. 

35b. 
IJ Tr. Aconiti gtt. viij. 
Aq. Amygd. am. c. 
Sp. nitrico-aeth. ^ 3 j. 
Aquae fontanae ad § j. 
3 j bis vel ter die. 

Hypertrophy 
without valv. lesions. 
35c. 
IJ, Tr. Aconiti gtt. vj. 
Extr. Gelsem. fl. 3 ss. 
Kali nitrici ±)]. 
Aquae destillatae § iij. 
| ss bihorio vel tert. horis. 
Nephritis. 
Urethritis. 



35d. 
r> Tr. Aconiti gtt. j. 
Glycerini § ss. 
Aq. destillatae ad ^ ij. 
| j orani hora. 
(1 year.) Febrile Diseases. 

46. 
rj iEth. acet. vel sulf. 

Alcoholis ^ 3 ij. 
Gtt. x — xxx ex aqua. 

Fainting. 
37. 
tj Amyl. aeth. nitrosi 

Alcoholis ^ 2.5. 

Gtt.ij— jv. Spasm. Glottid. 

38. 
ty Anilini sulfurici 
0.05—0.15 ter die in pil. 
(0.14 p. diem.) Chorea. 
(13 years.) Epilepsy. 

After a few days the dose 
may be doubled. 



Aconit Rad. Tr. : gtt 
Aconitin: gr. 1-400— 
^Ether acet. 
^Ether sulf.: 
Amyl Nitris 
Anilin: 



2—8 = 
1-100= 
gtt. 10 — 3 ss= 
gtt. 20— 3 j = 
gtt. 1—5 = 
gr. 1 — 4 



0.065. —0.26. 

0.00015—0.0006 

0.25 —2.0. 

0.5 —4.0. 

0,03 —0.15. 

0.065 —0.25; 1.0 p.diem. 



Aconite: In febrile diseases, if skin hot and dry, and 
the pulse rapid and strong, see Veratrum. If much pros- 
tration or the pulse becomes feeble, it must be stopped or 
given in smaller doses. Contra-indicated in asthenic cases. 
It is also used in sudden suppression of Menses, Tonso- 
litis, Pharyngitis, Pneumonia and Basedow's disease. 

In Headache, Pleuritis, Cellulitis, Tr. Aconit. gtt. j 
every 15 minutes fori or 2 hours; afterward gtt. j hourly. 

In Abortion, with Sod. salicyl. gr. xv every 3 hours. 



Antisjiasmodics, Narcotics, etc. 23 

39a. 41a. 

I£ Tart, emetici gr. jv. IJ Asa* foetidae. 

Aquae destillatrc 3 jv. Extr. Valeriana? £ 3ij. 

5 ij omnihora. Craving for Ferr. sulfurici 3j. 
Drink. F. pilulae 20. 
39b. j mane nocteque. Chorea. 

IJ Tart, emetic, gr. v. y e j. 

Kalinitrici 3j. ^ Tr." As® foetid* 3 ii. 

Divide in p. aeq No. 6. rft , Valeriana 3 ss. 

j tert horis. ^n^j^tc. 3 j ter dJe Flatu i ent Colic. 

II Atrop. Sulfatis 0.1. _ _ A 4lb ; , 

Strychn. Nitratis 0.2. * Tr. Asa, foetid* 10.0. 
Chin. Sulfatis 2.0. Jr. Castorei Canad. 

Pot. Bromidi Jr. \alerianae a 5.0. 

Extr. Trifolii ? 10.0. „ Tr ' °P 11 _. rx 2 ; 5 ' 
Rad. AlthttSB 3.0. Gtt 30 - 50 ter die * ^W™" 

Rad. Artemisia? q. s. 42. 

F. pilulae 200. Epilepsy. # Pil. Atrop. gr, 1-120. 

j daily the first fortnight. Hora somni. Night Sweat. 

j bis die the next. 43a. 

j ter die afterward for one 5, Extr. Belladonnas 0.25. 
month (if they be borne; Aq. Laurocerasi 15.0. 
after this to decrease again. Gtt. xx — xxx quater die. 

Antim. Pot. Tart.: gr. £ — 3 = 0.008 — 0.2. 

Asafoetida: gr. 5 — 30 = 0.32 — 2.0. 

Asafoet. Tr.: gtt. 20— 3j = 1.0 —4.0. 

Atropia: gr. 1-200—1-50 = 0.0003 0.0012. 

Bellad. Extr.: gr. \— 2 = 0.032—0.13. 

Antimony: In the first stage of Rhinitis, Pharyngitis 
and Bronchial Catarrh. In Delirium of Typhoid, gr. 
1-16 — 1-8 every \ hour. In No. 39b the Antimony may 
be increased in the next six powders to gr. vi. They 
are reputed to extinguish any fever. 

Belladonna (see Hyoscyamus) prevents secretion of 
milk, arrests profuse perspiration and prevents griping of 
some cathartics. In Asthma, Tr. Bell. gtt. x bihorio until 
vision affected. In Epilepsy, Extr. Bell. gr. 1-5 per diem. 



24 



SEDATIVES: Anodynes, 



43b. 
IJ, Extr. Belladonna? gr. j. 

Sacchari Lactis 3j. 
Divide in 10 partes, 
j hora somni. Pe7*tussis. 

(1 year); double for 5-10 yrs. 

43c. 
IJ Extr. Bellad. fl. gtt. viij. 
Spir. nitrico-a3tb. 3j. 
Syrupi simplicis 
Aq. Cinnamomi T § j. 
Gtt. ij for eacb year ter die 
Preventive of Scarlatina. 
43d. 
5 Extr. Bellad. fl. gtt. jv. 
Tr. Xantoxyl. gtt. x. 
Aq. Amygd. am. c. 3 j 
Aq. Flor. Tilige 3 iij. 



3 j every 1 5 min. Hypertrophy, 



^ Syr. Belladonna 30.0. 
Aq. Laurocerasi 10.0. 
Aq. Flor Tilise 110.0. 
3 i j bihorio. Pertussis. 
44. 
$ Extr.Berb. aquif. fl. § j. 
Ext.Viburniprunif. 3 ss. 
Tr. Pulsatilla? 3j. 
Syr. Tolu, ad § jv. 
3 j ter die ante cibum. 
Dysmenorrhcea. 
Leucorrhoea. 
45a. 
^ Bromi (gtt. 3) 0.1. 
Kalii bromati 0.25. 

Aq. destillatae 120.0. 
3 j omni bora ex aqua. 



Diphtheria. 



Bellad. Extr. fl.: gtt. 1— 4 = 0.032—0.13. 

Bellad. Tr. " 8—30 = 0.025—1.0. 

Berberis,Extr. fl.:" 15— 3 j = 1.0 —4.0. 

Brom.: gr. 1-10— \ = 0.006—0.03. 



It is also used in Palpitation and Vesical Irritation. 

Berberis is said to be of especial benefit in Leucorrhoea, 
not dependent on mecbanical causes. (See section v.) 
In Cardialgia it is sometimes of service. 

Brom must be mucb diluted if used internally; a solu- 
tion of 1-100 gtt.10 — 20may be given hourly or every 
two hours, Acid, hydrobrom. dil. in 3 i doses makes with 
sugar-water a good lemonade, or with Sod. bicarb. ( 3 ss) 
a pleasant efferverscing draught. 

Bromides reduce the amount of blood to the brain; 
reflex irritability of the spinal cord, and excitability of 
the generative organs. Lithii Bromidum (Lithium 
bromatum) by its anaesthetic influence through the 



Antispasmodic*^ Narcotics, etc. 



25 



45b. 

IJ Bromi (gtt. j.) 0.03. 

Kalii bromati 0.1. 

Aq. destill. 150.0. 

Syrnpi simplicis 50.0. 

5 ss omni hora. Croup. 

46. 
5 Acid, hydrobr. dil. 5.0. 
Aquae Menthse 200.0. 
Syr. Aurant. Cort. 50.0. - 
3 ss tertils horis ex aqua. 
Dyspepsia. 
Vomiting of Pregnancy. 
47. 
IJ Lithii Bromidi 5.0. 

Aq. destill. 200.0. 

Syr. Aurant. C. 50.0. 
3 ss ter vel quater die. 
Epilepsy. 
Hysteria. 



48a. 
5 Pot. Bromidi 3j. 

Chlorali gr. v. 
Bihorio. Erysipelas. 

( if delirium. ) 

48b. 

IJ Kalii bromati 3.0 — 5.0. 

Chlorali 1.0—1.5. 

Sleepingpowder (in water). 

48c. 
IJ Pot. bromati 
Chlorali 2 gr- v. 
Aq. fontana? 5 j. 
3] every 15 minutes. 
(1 month.) Convulsio7is. 

49a. 
r> Pot. Bromidi 3 ss. 
Elix. Valer. arnm. 3 j. 
Spir. Vini Gallici 3 ss. 
Alcoholism. 



Acid, hydrobrom. dil. 
Brom. Ammonii: 

" Lithii: 

" Potassii: 



gtt. 15— 3 i 
gr. 3—30 
gr. 3—15 
gr. 4—40 



1.0 —4.0. 
0.2 —2.0. 
0.2 —1.0. 
0.25—2.6. 



afferent nerves, allays any excitement of spinal origin, 
like most Bromides; but as it does not affect the heart's 
action, like Pot. brom., it may be used for a long time 
without producing any apparent deleterious effects upon 
the circulation. It is, moreover more powerful than 
Potass., and as easily soluble; and may be combined 
with Belladonna, Cannabis, Chloral, Hyoscyamus, 
Opium, etc. Potassii Bromidum (Kalium bromatum) 
influences heart, respiration and temperature; too much 
used, it will cause low temperature, fatigue, slowness of 
speech, forgetfulness and general cachexia, etc. Aver- 
age dose, 0.3 — 1.0 bihorio vel tert. horis. 1.0 — 3.0 bis 



26. 



SEDATIVES: Anodynes, 



49b. 
]J Kal. bromati § ss. 
Extr. Cocae fl. 3 iij. 
Tr. Capsici 3 i. 
Elix. Val.amm. ad f jv. 
1 ss every hour until re- 
lieved. ( Wakefulness 
after debauch, headache; 
and to allay itching.) 
49c. 
r> Pot. Bromidi 5.0 

Liq. Ferri Chloridi 
Tr. Strychnin. a 1.0. 
" Capsici 2.0. 

Aq. fontanse 150.0. 

| ss quater die. 

Mixt. potatorum. 
50a. 
r> Pot. brom. 3 iij. 

Extr. Cannab. fl. 3 ss. 
Aq. destillatse § vj. 
? ss.ter die. Asthma. 



50b. 
r^ Pot. brom. 

" bicarb. ^ 5.0. 
Extr. Gelsem. fl. 0.5. 
Aq. destill. 60.0. 

3 j ter die. Migraine. 

Neuralgia of Quintus. 
{Especially dental nerves.) 

51a. 
£>, Kalii bromati 

Chlorali, 7 3 ij. • 

Morph. sulf urici, gr. jss. 
Aq. destillatoe § vj. 
| ss ex aqua every 4 hours 
while in pain. 

Dysmenorrhea. 
( Ovarian and membran.) 
51b. 
Ijfc Pot. Bromidi 3 ij 

Sol. Morph. U. S. § ij. 
3 j bihorio while in pain. 
Abortion. 



Brom. Sod.: gr. 5—45 = 0.32—3.0. 



vel ter die. Sodii jBromidum (Natrium bromatum) is 
superior to the Potass., as it has none of its unpleasant 
effects, and moreover debilitates less the muscular sys- 
tem. 

Bromism: Idiotic expression, vacant look and stag- 
gering gait. Arsenic and Strychnine are recommended, if 
large doses have been employed, to prevent intoxication. 

In Epilepsy, Amm. brom. 0.5 — 1.5 ter die; children 
according to age; Lith. brom. gr. ij — x, well diluted. 
In severe cases either has to be used constantly for 
about 6 months. Pot. brom. 3j ter die, to be gradu- 
ally increased to 3 j pro. do si until Bromism. In Per- 
tussis, Amm. brom. 0.1 — 0.4 ter die. In Hysteria, Lith, 



Antiperiodics, Antiseptics, etc. 



27 



51c. 

IJ Pot. Bromidi 3ij — 3 j. 

Sol. Magendie gtt. ij. 

Syr. Acacise 3 j. 

Aq. destillatxe 3 iij. 

3 ij ter die. Pertussis. 

(1 year) 

52 a. 
IJ Kalii bromati 

Amnion, brom. a 10.0. 
Aqua? destillata? 50.0. 
3 j orani hora. Delirium 

tremens. 

52b. 

U Pot. Bromidi 30.0. 

Aram, Bromidi 7.5. 

Pot. Iodidi 4.0. 

* Bicarbon. 2.5. 

Inf. Colombo 180.0. 

3] ter die ex aqua ante 

cibum et 3 j hora somni. 

Epilepsy. 



2.0. 
4.0. 



53. 
IJ Kalii bromati 

Extr. Ergota? fl. ? 3 ij. 
Spir. Amm. arom. 
Tr. Xue. Vomic. 7 3 j. 
Aq. Mentha? ad 3 viij. 
3 ss quartis horis. 

Haemorrhoids. 
54a. 
IJ Camphora3 
Ergotae 
G. arabici q. s. 
F. pilulse 50. 
j mane nocteque. Pollu- 
tions, (nocturn.) 
54b. 
IJ Camphone 3 ss. 

Extr. Hyoscyami 
vel Extr. Humuli 3ij. 
Rad. Ipecac, gr. x. 
F. pilulae 20. Strangury. 
ij ter die. Spermatorrhoea. 



Camphora: 



Spiritus: 
monobrom. 



gtt. 
gr. 



2—10 = 0.13—0.65. 
10—40 = 0.32—1.3. 
3—15 = 0.2 —1.0. 



brom. 0.5 — 2.5; in Delirium tremens and Spermatorr- 
hoea, 10.0 p. diem. In Cellulitis, Pot. brom. gr. xto 3j 
tert. toris; in Headache and Delirium of Pneumonia, 
3j ter die. In Convulsions, gr. ij — v every half hour if 
necessary. (1 month — 2 years.) Also in Enuresis, 
Spasm of Bladder and Rectum, Dentition and Strych- 
nine poisoning. 

Camphora allays nervousness and quiets restlessness, 
producing a general placidity of feeling. It is an effi- 
cient remedy in Strangury caused by Cantharides, and 
in some forms of Colic, especially of hysterical subjects. 



28 



SEDATIVES: Anodynes, 



54c. 
IJ, Camphorae 

Pulveris Doveri 
Extr. Hyoscyami 2 3j 
F. pilula3 20 
j mane nocteque. 

Dysmenorrhea, 
(nervous.) 
55a. 
IJ Camphorae 0.12. 

Amm. carbon. 0.5. 
Sacchari 1.2. 

Dentur tales doses 10. 
j semis horis. Cholera. 

Vel: 
5 Camphor liquidae 

Tr. Valerianae ^ 5.0. 
Gtt. xx — xxx c. Sacch. 

55b. 

fy Camphorae 1.0. 

^Eth. acetici 12.0. 

Tr. Opii 3.0. 

Gtt.x — xv. every 15 or 30 m. 

Cholera, (asphyct.) 



55c. 
]J Camphorae 

Mih. acetici 7 10.0. 
Tr. arom. acidae 5.0. 
Alcoholis 15.0., 

Gtt. jv. — vj. Preventive of 
Cholera. 
56. 
1)6 Camphorae 3 hs. 
Sacchari § ss. 
Amygd. decort. No. 6. 
Contere, dein adde gradat. 

Aq. Menthae | viij. 
Pars 1-6 quartis horis. 

Neuralgia, (hysteric.) 
Vel: 

^ Camphorae 3.0. 

Chloroformii 17.0. 

Gtt. x ter die. Neuralgia. 

57. 
IJ Ext. Cannabis Indie. 

Pulv. Valerianae ^ 3j. 
F. pilulae 40. 
j ter die. Hysteria. 



Cannab. 



Ind. 
Tr. 



Extr. fl.: 



gtt. 1- 
gtt. 10- 



-4 
-60 



0.032—0.13. 
0.32 —2.0. 



In Congestion of Kidneys, gr. ij — v. may be given. 
In Dysmenorrhoea (ovarian), the Monobr. gr. v. • 

Cannabis is in small doses stimulating to the nerves, 
especially the sexual; in large, hypnotic. It is some- 
times used in Tetanus, Acute Mania, etc., and although 
uncertain, it is often a very efficaceous narcotic in Sleep- 
lessness, Neuralgia and other painful diseases. 

In Metrorrhagia and Dysmenorrhoea (ovarian and 
neuralgic), Tr. gtt. xxv quartis horis. In Incontinence 
of Urine from paralysis vesicae, Extr. fl. gtt. ij bis die. 



Antispasmodics, Narcotics y etc. 



29 



8.0. 
2.0. 



58 a. 
R Tr. Castorei 

JEtheris sulfurici 
Vel: 

R Tr. Castorei 6.0. 

Spir. camphorati 4.0. 
Gtt. xv — xxx ter die. 

Hysteria. 
Vel: 

\\ Tr. Castorei 3 j. 
Tr. Camph, comp. 
Spr.Lavand.comp/a 3 ss. 
I Bsbihorio vel tertiis horis 
ex aqua. Hysteria. 

58b. 
IJ Tr. Castorei 

" Valer. aeth. 1 10.0. 
" Opii crocat. 5.0. 
Gtt. xv — xxx ter die. Same. 
Vel: 

3 Tr. Castorei 40.0. 

" Valerianae 10.0. 

Aq. Laurocerasi 50.0. 

3 Bfl tertiis horis. Same. 

Vel: 

Q Tr. Castorei 3j. 
JEtheris 

Laud an i 7 gtt. x. 

Aqua? Cinnamomi § jss. 

Same. 

Castor. Tr.: 3 ss 

Cerii Oxalas: gr. 1 

Chloral: gr. 10 



58c. 
5 Tr. Castorei 

" Valeriana? a 5.0. 

Spir. a?therei gtt. xv. 

Aq. Fceniculi 100.0. 

3 ss tertiis vel quartis horis. 

Antispasmodic. 

Vel: 

t> Tr. Castorei 
" Valeriana? 
Liq. Amm. succ. ^ 3.0. 
Tr. Opii 1.0. 

Gtt. xv — xxv ter die. 

59. 
I> Cerii oxalici gr. v — x. 

Sacch. Lactis gr. ij. 
Dentur tales doses 6. 
j ter die. Cough. 

{Phthisis.) 

60a. 

5 Chlorali 5.0. 

Aq. destillata? 10.0. 

3 j ex vino, cerivisiavel inf. 

8. lini. Liq. somni ferns. 

60b. 

fy Chlorali 4.0. 

Glycerina? 40.0. 

Aq. Mentha? 150.0. 

3 ss ter die; 3 j hora somni. 

Mixt. ant iphth isic. 

— 3j == 2.0 —4.0. 
—5 = 0.065—0.32. 
40 = 0.65 —2.6. 



Cerium \< sometimes employed in Pertussis, 0.03 (1 
year) 0.08 (7 years) once a day before breakfast. 

Chloral,** sedative: 0.5 — 1.5 omni hora vel bihorio 0.1 
— 0.2 for children; as hypnotic: 2.5 — 5.0. For child- 
ren, 1—3 years: 1.0 — 1.5; 3 — 5 years: 2.0 — 3.0; 5 — 1 



30 



SEDATIVES: Anodynes, 



60c. 

5 Chlorali 20.0. 

Natri nitrosi 3.0. 

Tr. Stramonii 10.0. 

Aq. Menthaead 120.0. 

3 ii quartis horis. Asthma. 

61a. 

]J Chloroformii 10.0. 

Alcoholis 25.0. 

Tr. aromaticse 30.0. 

Gtt. xx — lx. Migraine. 

Neuralgia, etc. 

Vel: 

5 Chloroformii 10.0. 

Tr. Valer. geth. 20.0. 
Morphii acetici 0.1. 

Gtt. xxx ter die. 

Hysteria, etc. 
Vel: 

^ Chloroformii 5.0. 

Alcoholis 40.0. 

Mixtis adde conquassando 

Syrupi simplicis 140.0. 

3 ij — § ss pro dosi. Colic. 

Asthma. 



10.0. 
15.0. 

75.0. 



61b. 
g, Chloroformii 5.0 

Tr. aromatic83 10.0 

" amarae 30.0 

3 ] ex vino subinde. 

Sea-sickness, 
Vel: 
5- Chloroformii 

Alcoholis 
Mixtis adde 

Glycerinse 
Turn fortiter conquassa. 

62a. 
IJ, Tr. Cocci Radem. § ss 
Aq. destillatae 3 iijss 
I ss ter die ex aqua. 

Chronic Nephritis, 
[Painful and frequent mic- 
turition. ) 

62b. 
5- Cocci gr. x. 
Pot. bicarb. 3j. 
Aq. Fontis § jv. 
3 ij ter die. Pertussis. 

(1 year). 



Chloroform: 
Coccus: 



gtt. 6—30 
gr. 1-6—1-2 



= 0.16—0.78. 
= 0.01—0.032. 



years: 3.0 — 4.0. In neuralgic Headache, gr. xlv. in 
three doses within one hour. In Tetanus, 2.0 ter die; 
8.0 per diem. In Delirium tremens, 7.0. In Dysme- 
norrhea (neuralgic and ovarian), 3j every 8 hours. In 
Enuresis nocturna, 0.5 — 1.5 in 2 or 3 doses half hourly 
in the evening. (3 — 10 years.) However, of the great- 
est value it is in Parturition, especially in case of rigid 
os: 3ij in 2 doses within half an hour. 

Chloroform is contra-indicated in valvular lesions; 
and in acute febrile diseases it has to be used with care. 



Antiperiodics, Antiseptics, etc. 



31 



63. 

IJ Coniini 0.005. 

Alcoholis 1.0. 

Aq. destillata? 12.5. 

Gtt. xv — xxx ter die. 

Photophobia. 
64a. 
IJ Ext. Conii 

11 Hyoseyamu gr.xv. 
Opii gr. jv. 
F. pilulae 6. Peritonitis. 
j nocte. {if much pain.) 
Vol: 
IJ Extracti Conii 

Pulveris Doveri H 3 ss. 
F. pilul» 12. 
j vel ij subinde. Same. 

64b. 
IJ Extr. Conii fl. 

" Hyosc. fl. T 3 ss. 
Sol. Chlorali (3ij) § ij. 
1 ss at bedtime. Hypnotic. 



IJ Curare gr. : V. 

Sacch. Lactis gr. ij. 
Dent. tal. dos. 6. 
j ter die until general pare- 
sis. Tetanus. 
Gr. J to be repeated in 1 5 
min.; and after 1 hour gr. 
\ if necessary. 

Hydrophobia. 

66a. 

IJ Acidi hydrocyanici dil. 

m. iv. 

Pot. bicarb. gr. x. 

Aq. fontana} 3 ss. 

This dose bis die. 

Irritable Stomach. 
66b. 
IJ Kalii cyanati 0.05. 

Aq. destillata3 5.0. 

Gtt. xv — xxx ter die. 

Gastralgla. 



Conii Extr,: gr.l — 8 = 0.065—0.5. 
Con i in: gr. 1-60—1-30= 0.001—0.002; 0.003 p. diem. 
Curare: 1-60 — 1-12= 0.001 — 0.005. 

Cyan. Pot.: gr. ^— i = 0.008— 0.015. 
" " Acid, hydroc. dil. gtt.: 1—5 = 0.085—0.43. 

In Colic, gtt. xx at short intervals, with hot fomenta- 
tions. In Colica saturnina, gtt. v — xx tertiis horis. In 
Cholera and Congestion of Brain, 2.0 — 3.5; in com- 
mencement of Intermittens, 3 j in water to induce sleep. 

' bnium causes muscular relaxation, and is employed in 
enlargements of liver and abdominal organs. Its effects 
are much heightened when combined with Morphine. 

Cyan-Praep. are of variable and consequently un- 
certain strength, and as they belong to the most deadly 
poisons, they have to be employed with the greatest 



32 SEDATIVES: Anodynes, 

67. 68b. 

3 Aq. Amygd. am. c. ^ Aq. Laurocerasi 

Sod. Bicarb. 7 3 ij. Tr. Hyoscyami ^ 3 j. 

AquaB fontanae § vj. V el Extracti fluidi gtt. xx. 
I ss vomitione urgente. Aq. Aurant. Fl. 3 ij. 

68a - m 3jomnihora. Gastritis. 
]J Aq. Laurocerasi 7.5. 68c 

Tr. Digitalis 5.0. n A T 

Gtt. xx ter die. Palpitation. » Aq. Laurocerasi jw. 

Vel- Syr. Fl. Aurantn § ]. 

9 Aq. Laurocerasi K A * ^sarum ad 1 jv. 

Tr. Valerianae 3 ss ter die - Laryngitis. 
Spir. aeth. sulf. 69 - 

'< camphorati ^T3j. r> Extr. Cypripedii fl. 
3 ss ex aqua. Hysteria. Aq. Aurant. Fl. ^. 5.0. 

Spasmus Glotticlis. 3] ter die. Migraine. 



Cyan. Aq. Laurocerasi: gtt. 5 — 3 ss = 0.3 — 2.0. 
" " Amygd. am. c.:gtt. 20— 50 = 1.2 —3.2. 
01. Amygd. am. aeth.: gtt. \— | = 0.015—0.03. 
Cypriped. Extr. fl.: gtt. 15 — 30 = 0.5 —1.0. 

caution. Aciclum hydrocyan. dil. contains 2 p. cent of 
anhydrous acid. About gtt. ij should be given at the 
beginning and gradually increased until its effect is 
obtained; and the intervals need not exceed two hours, 
as it is improbable that the drug exerts any influence 
whatever upon the system one hour after ingestion. 
(ScheeWs medicinal acid contains 5 p. cent, of anhy- 
drous, therefore 2 m. of it are equal to 5 m. of the IJ. S. 
acid). Potass, cyan, is sometimes used instead of the 
acid, as it is less liable to undergo decomposition. 

Aqua Amygdal. TI. S. is mostly used as a vehicle, 
though it should not be given in larger than 3 ij doses. 

Cypripediumis a very valuable nerve tonic in hysteria, 
and all cases of nervous irritability; and in certain diseases 
it is preferable to Opium, producing no constipation. 



Antispasmodics, Narcotics, etc. 



33 



70. 
IJ, Extr. Dioscorece fl. 3 ss. 
" Cypripedii fl. 
" Helon. fl. 7T 3 ij. 
3 ss — 3 j omni hora. ( hUc, 
[bilious.) 
71. 
5 Extr. Gelsem. fluidi 

Elix. simp]. ^ 3j. 
Gtt. x- -xxx bihorio vel tert. 
horis. Wakefulness. 

72. 
IJ Extr. Grindel. rob. fl. 

GlyceriDae ^ 3 ss. 
3 j every 15 min. during fit, 
afterward gtt. xv — xx ter 
die. Asthma. 



73a. 
IJ, Extr.Hyosc.gr.x — 3 ss. 

Pulv. Liquiritiae q. s. 
F. pilulse 10. Peritonitis. 
j bis die. {if much pain.) 

73b. 
IJ Tr. Hyoscyami gtt. xv. 

Spir. Amnion, foet. 3 ss. 

Aq. Amygd. am. c. 3 j. 

Aq. destill. q. s. ad 3 ij. 
3] ter die. Laryngismus 
(1 year.) stridulus. 

73c. 
IJ Tr. Hyoscyami 3 ij. 

Vini Ipecacuanha § j. 
Gtt. xx subinde. 
(3 months.) Pertussis. 



Dioscor. Extr. fl. 
Gelsemium " 
Hyoscvamus " 
Tr.: 



gtt. 10— 30 = 0.32—1.0. 

gtt. 3 — 20 = 0.1 —0.65. 

gtt. 5 — 20 = 0.16 — 0.65. 

gtt. 20— 3 j =1.0 —4.0. 



Gelsemium in too strong doses produces dilatation of 
pupils and Ptosis; afterward difficult respiration and 
paralysis of tongue and muscles. 

In Cellulitis it may be given until dilatation of pupil 
or Ptosis, and it is best to begin with small doses: Extr. 
fl. o.Oo—O.l (gtt. ij— iij.) In Toothache, Tr. gtt. x— xx 
(3 doses the most necessary). In Delirium tremens, gtt. v 
bihorio vel tert. horis; besides milk until vomiting ceases. 

Hyoscyamus may be given until dry throat and dilata- 
tion of pupils. Hyoscyamin, Daturin and Duboisin are 
identical, and similar to Atropin (as Stram.to Belladonn.) 

To procure sleep in children (2 years), Tr. gtt. x hora 
somni; in Spasm of Limbs, gtt. iij bis die; (1 month); in 
Strangury, gtt. iij — vj bihorio in 3 j of water. 



34 



SEDATIVES: Anodynes, 



74. 


75b. 


$ Lactucarii 5.0. 
Rd. Althaeae 0.5. 


5 Tr. Lobeliae 15.0. 
Olei Anethi gtt. v. 


Mucil. Acaciae q. s. 


Aq. destillatae 185.0. 


F. pilulae 50. Asthma. 


| j tertiis horis. Asthma. 


j hora somni. Cough. 
75a. 


75c. 
r>, Tr. Lobeliae 3 ij. 


5 Tr. Lobeliae 
" (Digitalis) 
Aq. Laurocerasi 


" Hyoscyami 

Spir. aetherei H 3 iij. 

Tr. Digitalis 3 ss. 


Spir. aetherei ? 5.0. 
3 ss omni hora. 


Mixt.Camphoraead § vj. 
3 ss pro re nata, vel durante 


Asthma. 


paroxysmo. Asthma. 


Lactucarium: gr. 3 


—12 = 0.2—0.8. 


Lobelia Tr. gtt. 20— 3 ij = = 1.0—8.0. 



.Lactucarium is similar to Stramonium, but milder; it 
is occasionally used in nervous irritation and where 
Opium is to be avoided. In conjunction with Cam- 
phora monobromata it geems to be of especial benefit 
in phthisical cough. 

Lobelia is milder than Nicotine and must be employed 
with caution. (Girls working at manufactures of tobacco 
get weakness of muscles, with or without Anaemia). Too 
strong doses produce Vomiting, Diarrhoea, Giddiness, 
Contraction of Pupils and Convulsions. Its action as 
emetic is too violent for its safe administration, but it 
may be used as enema to fulfill the indications of 
Tobacco. It is most employed in Asthma, Angina pec- 
toris, Neuralgia of heart and the dry and spasmodic cough 
from Hyperaesthesia of Pneumogastric: Tr. m. iij — v 
every 1 5 minutes, or gtt. xv every hour until slight nausea 
and relaxation. Its efficiency in these cases may be 
increased by giving it in conjunction with Ammon. brom. 
or iod. It has been recommended in habitual Constipa- 
tion, from atony of the muscular coat of the bowels. 



Antipcriodics, Antiseptics, etc. 35 

7 (3a. - 77 a. 

IJ Lycopodii 10.0. IJ Tr. Opii 

Extr. Viburni fl. 6.0. " " camph. ^ 3 ss. 

Syr. Althaeas 20.0. " Valeriana} 3 ij. 

Aq. destillata^ 64.0. " Rhei aquos. 3 j. 

3 ij — 3 ss omni hora. ^Eth. sulf. gtt. xxx. 

Cramp. Tr. Aconiti gtt. xv. 

76b. Dose, gtt. xx — xxv. 

I> Lycopodii 3j. Vel: 

Pulv. aromat. gr. x. Tr. Opii 1.0. 

Vanilini gr. ij. " Valer. 33th. 20.0. 

Boleti cervini gr. v. Vini Ipecacuanha 3.0. 

D.tal.dos.6 in caps, amylac. 01. Menth. pip. 0.15. 

j hora sonmi. Aphrodisiac. Gtt. xxx subinde. Cholera. 



Lycopodium: gr. 20 — 40 = 1.3 — 2.6. 
Opium: gr. J— 1 = 0.032—0.065. 

" Tr.: gtt. 6—24 = 0.25 —1.0. 

Opium: In all painful affections, but especially use- 
ful in inflammation of serous membranes, as Peritonitis, 
Pleuritis, Meningitis, etc. To a weak and dilated heart 
it is a tonic; it strengthens the heart's action, increasing 
the arterial tension and making the pulse fuller and 
firmer. It has, moreover, a specific influence on the 
action of orbicular muscles, such as the uterus, impart- 
ing an increased force of contraction, strikingly in con- 
trast with Belladonna, Hyoscyamus and other narcotics, 
which relax the muscular fibre. In order to avoid large 
doses and yet increase or modify the effect of Opium it 
is sometimes advantageous to combine it with other 
soothing remedies (Xos. 51, 54, 61, etc). In gastrointes- 
tinal disorders Opium should not be used if there be 
deficiency in proper secretion, as it arrests all secretions 
except that of skin, and in cases of Pneumonia it should 
not be given in full doses if there is an accumulation of 
mucous secretion in the bronchial tubes. As regards 



36 



SEDATIVES: Anodynes, 



77b. 
5 Tr. Opii gtt. Ix. 

Acidi nitr. dil. gtt. jv. 

Spir. nitrico-aeth. 3 j. 

Mixt. Camphorae | jv 

| ss post sing. sed. liquidas. 

Diarrhoea. 

77c. 

^ Tr. Opii gtt. x. 

Acid. nitr. dil. gtt. j. 

Mixt. Camphorae § j. 

Aq. destillatae § ij. 

3 ij postsing.sedesliquidas. 

(3 years.) Cholera Infant. 



77d. 

IJ Tr. Opii 0.5. 

Spir. nitrico-aeth. 2.0. 

Aq. Fl. Aurantii 100.0. 

3 ss bihorio. After pains. 

77e. 
rj Tr. Opii gtt. xv — xx. 
Spiritus Carvi § ss. 
Aq. Menthae § j. 

During fit. 
vel Morph. gr. \ — \ on 
tongue; to be repeated in 
\ h. or 1 h. if necessary. 

Gastralgia. 



Morphina: gr. 

0.2 p. diem; 0.0005- 



0.008—0.015. 
-0.003 for children. 



Bright's Disease, there is no fear of Opium being dan- 
gerous, on account of the blood being surcharged with 
urea; on the contrary, it will render the nervous system 
more tolerant of the uraemic poison. Children of less 
than 2 years should never have Opium, but if indicated 
Morphium is to be preferred. The latter affects the 
bowels and head less than Opium; neither does it inter- 
fere with the secretions of the mucous membrane, nor is 
it diaphoretic; but it affects more the contractility of 
the bladder. In using large doses of Opium, pupil, 
breathing and its soporific effect should be watched: 
somnolence should never become so great that the patient 
could not easily be aroused; and respiration should not 
be reduced below 12 p. min. (Morph. gr. j in 2 injections 
within 2 hours has produced deep narcotism; on the other 
hand, Opium gr. xxjv in Dysentery have been given 
with good result within 24 hours.) 

In spurious Insolation (if only faintness, pale skin, 
pulse weak and pupils dilated, etc.), it may be of ser- 



Antispasmodics , Narcotics, etc. 



37 



78a. 
$ Tr. Opii campfa. 3 ss. 
Aq. Amygd. am. e. 
Extr. Liquir. fl. a 3 ij. 
" Bell. fl. gtt. viij. 
Aq. fcenicttli ad 5 vj. 
1 sa tertiis horis. Cough. 

78b. 
1> Tr. Opii camph. 3 j. 
Extr. Bell. fl. gtt. j. 
" Ipecac, fl. gtt. jv. 
Grlycy rrh i zae fl . 3 j . 
Aquae Anisi ad 3 ij. 
3 j bi boric. Cough. 

(4 months.) 



79a. 
5 Pulv. Doveri gr. v. 

" aromat. gr. ij. 
Tbis dose every 6 or 8 brs. 

if necessary, 
vel Morph. gr. 1-8 — 1-6. 

Diarrhoea. 
79b. 
IJ Pulv. Doveri gr. x. 
vel Morph. sulf. gr. \. 
vel Code in. gr. ^. 
Hora somni with toddy and 
a hot pediluvium. 

Bronchitis. 
( abortive.) 



Opii Tr. camph.: gtt. 20 — 3 j— 



Codeina: 



gr. 



JL ]J_ 

4 i ■> 



= 1.0 —4.0. 

0.015—0.1. 



vice: Tr. Opii gtt. x, with brandy § ss. (In true Inso- 
lation it would be dangerous; see part II.) 

In Cerebrospinal Meningitis, Opium gr. j every bour 
or two. In Cellulitis and Endometritis, gr. j tert horis, 
avoiding narcotism. In Enteritis, Tr. gtt. xv — xx with 
turpentine stupes. In Convulsions from exhaustion, gtt. 
j with v of brandy to infants of less than 1 year. In 
Trismus nascentium, gtt. j omni hora. In Vomiting and 
Nausea of Pregnancy, Sol. Magendie gtt. ij — iij ex aqua. 
In Peritonitis (general or pelvic), Morph. gr. J — J 
bihorio. In Asiatic Cholera, gr. j on tongue, to be re- 
peated in half bour until dejections cease. Here, as well 
as in sporadic Cholera, Morph. may be given again at 
once if rejected; but if again rejected, Opium may be 
tried in enema, and if this be once or twice quickly 
returned, then hypodermically. Either remedy should 
not be repeated before half an hour, as a shorter inter- 
val might produce narcotism. In Diabetes mellitus, 
Codein. gr. \ ter die, to be increased gradually to gr. ij. 



38 



SEDATIVES: Anodynes, 



80a. 
3 Morph. acetici 0.1. 

Glycerine 20.0. 

Aq. Cinnamon. 100.0. 

Aq. destill. 180.0. 

3 ss ten. vel quartis horis. 

80b. 
5 Morph. sulfur, gr. j. 

Atrop. sulfur, gr. -J. 

Cerii oxalici 

Sacch. Lactis ^ 3 ss. 
Divide in part sequal No. 16. 
jquaterdie. Gastric Ulcer. 



80c. 
5 Morphin. Acetatis 0.25. 
Aceti purl 5.0. 

Aq. destillatse 30.0. 
Gtt. x hora somni. 

Hypochondriasis. 
81. 
]J Aceti RutaB ( § j) Oj. 
3 j ter die. Chorea. 

82. 
$ Tr. Valeriana 30.0. 

Spiritus setherei 4.0. 
Gtt. xx — lx subinde. Colic. 



Ruta, Extr. 


fl. 


gtt. 


20 - 


-40 = 


0.65- 


- 1.0, 


Valer. " 


u 


gtt. 


15- 


-3j — 


1.0 - 


- 4.0 


" Tr.: 






3j- 


-3SS= 


4.0 - 


-16.0 



Tr. Opii gtt. 20 = gr. j; 2r. Opii carnph. | s^= gr. j. 
Sol. Morph. TJ. S. § j =gr. j; Magendie, 3 ss = gr. j. 

Syr. Morph.: Morph. acet. 0.1, Acid. acet. dil. gtt. v. 
Syr. spl. 200.0. ( 3 j = 0.002 pro dosi). 
JPulv. Ipecac comp.: Pot. sulf. gr. viij. 

Ipecac, and Opium, 7 gr. j. 
Chlorodyne: Morph. sulf. gr. jv, Extr Cannab. gr. viij. 
Chloroform, 3 j, 01. Menthse pip. gtt. jv. 
Tr. Capsic. gtt. ij, Alcoh. et Glycerin, ad § j. 
Dose, gtt. 20; for children, gtt. 3 — 8, according to age. 

Ruta has a decided influence on the uterus and is used 
in Amenorrhea as well as in Uterine Hemorrhage; in 
the latter, when it is dependent on an atonic state of the 
organ. It may be given gr. 15 — 3 ss. ter die in infusion. 
It is sometimes very effective in Colic, especially of 
hysterical subjects. 

Valeriana'^ as Antispasmodic one of the most popular 
remedies in Germany. Especially valuable in Hysteria 
and some cases of Hypochondriasis (Nqs, 41, 58, 77). 



Antispasmodics j Narcotics, etc. 39 

83. 84c. 

IJ, Vanilini 0.05—0.15. fy Tr. Veratri vir. gtt x. 

Bis vol ter die. Syr. Scillre comp. 3 ij. 

Antispasmodic. " tolutani ad § ij. 

84a. 3 j tertiis horis. 

5 Veratrini 0.05. (4 years.) Bronchitis. 

Alcoholis 2.0. 85. 

Syr. simplicis 50.0. 5 Extr. Viburn. prunif. fl. 

Aq, Fontis 120.0. Extr. Helon. fl. £ 3 ij. 

3 ss bihorio until sick feel- " Dioscor. fl. 3 j. 

ing. Febrile Diseases. Gtt. x— xxx ter die. 

84b. Dysmenorrhcea. 

IJ Tr. Veratri viridi 1.0. [neuralgic.) 

Syr. simplicis 30.0. 8$. 

Aq. fontana3 100.0. ]J Extr. Xanth. spin. fl. 

3 ss every 15 or 30 minutes. Gtt. x — xx ter die. 

(Children 3 j. ) Cholera. Hydrophobia. 

Vanillin: gr. \— 2 =0.03 — 0.13 ter die. 

VeratrurnTr. gtt. 2 — 12 =0.065—0.4. 
Veratrin: gr. 1-40 — 1-12=0.0015— 0.005 ter die. 

Viburn. Extr. fl. : 3 ss — 3 jss=2 0—6.0. 
Xanth. Extr. fl.: gr. 2—10 =0.1 — 0.6 ter die. 

Vetairum : In febrile diseases where pulse is weak and 
rapid. (See Aconite.) As soon as nausea or diaphoresis 
begins, it has to be stopped or at least to be diminished. 
In puerperal convulsions hypodermically (page 110). 

In Abortion, Cellulitis, etc. Tr. m. j — ij bihorio with 
Sod. salicyl. gr. xv tert. horis. 

Viburnum is used in Uterine Hemorrhage, and as 
prophylactic in Abortion, threatening or habitual. In 
Dysmenorrhcea (without mechanical obstruction), Extr. 
Viburn. comp. fl. 0.5 — 1.0 ter vel quater die. In Cramps 
of legs or feet, Tr. gtt. x ter die. 

Xanthium (No. 86 )has to be used at least for a month, 
though its efficiency is more than doubtful. For child- 
ren is the dose 0.3. 



SECTION III. 



CORRECTIVES AND ELIMINATIVES. 

Under this head are counted Acids, Antacids, Ex- 
pectorants, Diaphoretics, Diuretics, and all those 
medicines which correct and improve digestion by sup- 
plying the system with the required material; or which 
eliminate various substances from the body by increas- 
ing the activity of the secretory glands at fault. 

Acidum citricum: Refrigerant, Antiscorbutic. 

Acidum hydrochlor. d. : Antalkaline, Antiphosphatic, 
Alterative. 

Acidum nitricum dil: Antilithic, Alterative. 

Acidum nitro-muriaticum d.: Antilithic, Antiphos- 
phatic, Antisyphilitic. 

Ammonium: Antacid, Diaphoretic, Diuretic, Expec- 
torant, Stimulant. 

Apomorphina: Expectorant, Emetic. 

Benzinum: Vermifuge. 

Benzoin: Expectorant, Antispasmodic. 

Bismuthum: Antacid, Antiseptic, Stimulant. 

Blatta: Diuretic. 

Buchu: Diuretic, Stimulant, Tonic. 

Cantharis: Diuretic, Stimulant. 

Carbo: Antacid, Absorbent. 

Cimicifuga: Diaphoretic, Diuretic, Anodyne. 

Colchicum: Diuretic, Antiarthritic, Sedative. 

40 



Correctives an d Elim i natives. 4 1 

Copaita: Diuretic, Stimulant, Cathartic. 

Creta: Antacid. 

Digitalis: Diuretic, Tonic. 

Jaborandi: Diaphoretic, Sialogogue. 

Lithium: Antacid, Diuretic. 

Magnesia: Antacid. 

Opium: Narcotic. (See section n.) 

Pareika: Diuretic, Astringent, Tonic, Sedative. 

Potassium et Sodium: Antacid, Diuretic, Refriger- 
ant. 

Sanguinaria: Expectorant, Alterative, Refrigerant, 
Emmenagogue, Emetic. 

Scilla: Diuretic, Expectorant, Stimulant. 

Toxicodendron: Diaphoretic, Diuretic, Stimulant. 



42 CORRECTIVES and ELIMINATIVES: 



87. 


89. 


t), Acidi citrici 5.0. 


IJ Acidi nitr. d. 3 jss. 


Glycerinao 100.0. 
Aqu*e Fontis ad 1000.0. 


Tr. Card. comp. 3 ij. 
Aq. Fl. Aurant. § j. 


During the day. Potits 
Diabeticorum. 


Syr. simplicis ad § vj. 
3 ij omni hora vel bihorio. 


88. 
^ Acid, kydrochlor. d. 3 j. 
Glycerinse § j. 


(2 years.) Pertussis. 

90a. 
]J Acidi nitro-mur. dil. 


Aq. fontanae ad § viij. 
| ss bihorio and as gargle. 


Spir. nitrico-seth. ^ 3 ij. 
Aq. fontanse ad § viij. 


(4 — 7 years.) Scarlatina. 


§ ss ter die. Oxaluria. 



Acid, citricum: gr. 10 — 30 = 0.65 — 2.0. 
" hydrochl. d.: gtt. 5—30 = 0.35—2.15. 
" nitr. dil.: gtt. 2—20 = 0.15—1.5. 
" nitro-mur. d.: gtt. 2 — 20 = 0.14 — 1.4. 

Vegetable Acids form, properly diluted, refreshing 
drinks in febrile diseases. Acid. citr. is more used than 
Acid. acet. because the latter produces often Colic or 
Diarrhoea; however in Typhus, Scarlatina, etc., vinegar 
is preferable. Acid. tart, is a good substitute to citric 
acid, on account of its being cheaper. Acid. citr. 3j 
to sugarwater Oj is a refreshing lemonade. Succus Citri 
et Aqua, JT will often afford relief in Vomiting of Preg- 
nancy. 

Acidum aceticum dilutum (Vinegar), 1:7 Aqua. 

Mineral Acids, when properly diluted, allay not only 
thirst, but increase also the appetite. They correct 
moreover the morbid alkalinity of the blood in Typhoid 
and other essential fevers; and in Dyspepsia, when de- 
pendent on a deficiency of the gastric fluid, they are of 
great benefit, especially when combined with vegetable 
tonics. See section v. In Kater (Alcoholism): Acid, 
mur. d. gtt. viij — x e cyatho aquae. In Diarrhoea: Acid, 
nitr. d. gtt. j — ij ex aqua (it acts sometimes like a 
charm.) See part II. In Oxaluria: Acid, nitrohydro- 



Acids, Antacids, Expectorants, etc. 



43 



90b. 
R Acid, nitro-mur. d. 3jss. 
Extr. Pareirae fl. \ ss. 
Aq. font an ae ad 3 vj. 
3 ss ter die p. cibum ex 
aqua. Phosphates. 

91. 
II Acidi phosph. dil. 
Tr. Card. comp. 7 3 j- 
Inf. Colombo 3 jv. 
3 j ter die p. cibum. Same. 

92a. 
IJ Liq. Amm. acet. 3 ij. 
Spir. nitrico-aeth. 3 ss. 
3Iixt, Camph. ad 3 viij. 
P. J quartis horie. Dropsy. 

92b. 

tj Liq. Am. Acet. 3 j — 3 jv. 

Spir.nitr. oeth. 3 j — 3 iij 

Tr. Aconiti gtt. j— iij. 

Bihorio (if pulse full and 

bounding.) Erysipelas. 



92c. 
IJ, Liq. Amm. acet. 3 jv. 

Tart, emetici gr. j. 
3 ij every half hour with 
water until eruption re- 
appears. Convulsions. 
(in Scarlatina, etc.) 
93a. 
5, Amm on. carbonici 

Extr. Colombo fl. ^ 3 ss. 
Tr. Cardam. comp. 3 ij. 
Aqua3 Fontis 3 vj. 
I j bis die. Flatulency, 
(in gouty habits.) 
93b. 
IJ Ammon. Carbonatis 3 j. 
Extr. Senegse fl. 3 ij. 
" ScillcT fl. 3 j. 
vel Tr. Scillse § ss. 
Syr. tolutani § j. 
Aq, fontanae ad § viij. 
3 ss ter die. Cough. 



Acid, phosph. d. gtt. *0— 60 = 0.65— 4.0. 

Ammon. Acet. Liq.: 3 ss — § ss = 2.0 — 16.0. 

" Carbonas: gr. 3—10 = 0.2 — 0.65 



chlor. dil. gtt. x — xv ex aqua on empty stomach, espec- 
ially if taste foul or insip'd. 

Ammonii Acetas (Ammonum aceticum) is in small 
doses refrigerant, and in large ones diaphoretic and 
diuretic. It is readily prepared ex tempore by neutral- 
izing Acidum aceticum dilutum (m. xxvij: 3 ]) with 
Amnion, carb. (gr. xxiv.) 

In Dropsy, 3 ss ter die ex aqua. In Congestive Dys- 
menorrhea, 3 ij ter die ex aqua. In Convulsions from 
suppressed eruption of Scarlatina, to a child of 3 years, 
3 j ex aqua every 10 minutes after a mustard bath. 



44 CORRECTIVES and ELIMESTATIVES: 



94a. 
IJ Ammon. Chloridi 

Extr. Eucalypti fl. 
" Glycyrrh. fl. a 3 ij. 

Tr. Opii camph. § ss. 

Aq. Fontis ad § viij. 
1 ss tert. horis. .Phthisis. 
Vel: 
5- Ammon. nmriatici 

Succi Liquiritiae^ 5.0. 

(Tart. emet. 0.05.) 

Aq. fontanse ad 200.0. 
§ ss bihorio. Catarrh. 

94b. 
r> Ammon. Chloridi. 

Potass. Iodidi ^ 3 j. 

Succi Glycyrrh izae 3 ij. 

Aq. Fceniculi § vj. 
| ss ter die. Emphysem. 



94c. 
5 Ammon. chlorati 1.5. 
" picrin. 0.06. 
Succi Liquiritise 4.0. 
Aq. fontanae 100.0. 

3 ij omni hora. Pertussis. 
(I — 2 years; 3 j, 6 months 
or less.) 

94d. 
IJ Ammon. chlorati 3 ij. 
Extr. Xanthii fl. 3 j. 
Aq. Melissae | viij. 
3 j ter die. Hydrophobia. 

95. 
r> Tr. Apium mellif. 3 ss. 
" Pulsatilla 3 ij. 
Elix. simplicis ad § jv. 
3 j ter die. Masturbation, 
(iiocturnal emissions.) 



Ammon. Chloridum: 
" Liquor: 
" Spir. arom.: 
" Picras: 



gr. 3 — 15 = 0.2 — 1.0. 
gtt. 5—30 = 0.32 —2.0. 
gtt. 15— 3j= 1.0 —4.0. 
gr. • \—l =0.015—0.065. 



Aqua Ammonim. Aside from being used in acidity 
and flatulence, it is the physiological antidote to Alcohol, 
and a very good stimulant for speedily arousing the 
vascular and respiratory system; therefore, its employ- 
ment in Syncope, low forms of fever, etc. It is best 
given as Spir. Ammon. arom.; yet as antacid, stimulant 
and stomachic, Ammonii Carbonas is generally pre- 
ferred, (p. 73.) Ammonii Chloridum is not admissible 
if there be much inflammation. 

In Kater (Alcoholism): Aqua Ammoniae gtt. x — xxx 
e cyatho aquae; in Diabetes: Ammon. chlor. 1.25 quartis 
horis; in Intermittens: 3 j of the same during intermis- 
sion; in Facial and Dental Neuralgia: gr. x — 3j bihorio. 



Acids, Antacids, Expectorants, etc. 



45 



96a. 
^ Apomorph. hydrochlor. 
0.01 — 0.03. 
Acid, hydrochl. d.gtt. v. 
Syr. simplicis 50.0. 

Aq. Fontis 100.0. 

3 ss bihorio. Asthma. 

(pituitosa.) 
96b. 
I> Apomorphini gr. j. 
Acid, hydrochl.d. gtt. jv. 
Syrd^i simplicis § j. 
Aq. Melissa? 3 iij. 
3 j omni hora. Cough. 

3 years, ( 3ij: 7 years). 

97. 
1£ Benzin. lithanthr. 
01 ei Carvi 
Spirit us aetherei 
Gtt. xx — xxx ter die 



cibura. 



98. 
IJ Acidi benzoici 2.0. 

(Sod. bicarb. 5.0.) 
Sod. phosph. 10.0. 

(Tr. Hyoscyam. 10.0.) 
Aq. Cinnamomi 200.0. 
§ sster die. Lithiasis. 

98b. 

IjL Natri benzoici 2.5. 

" silicici 1.2. 

Extr. Aconiti 0.2. 

Colchici 0.6. 

Saponis medicati 0.5. 

F.pilulse20. Chronic 

ij — jv ter die. Cystitis. 

98c. 

IJ Magn. Benzoatis 7.5. 

Glycerini 20.0. 

Syr. simplicis 50.0. 

Aq. destillatae 100.0. 

3 ss bihorio veltertiis horis. 

Fla tulency. Gravel. 



5.0. 

1.0. 
10.0. 
post 



Apomorph in gr. 1-30- 
Benzoin. Acid.: gr. 8- 



30 = 



0.002—0.008. 
0.5 —2.0. 



Apomorphin is a prompt emetic and mostly used 
hypodermically, especially in narcotic poisoning, (p. 3*.) 
As expectorant it may be given 0.001 — 0.003 tert. horis. 

Benzoin resembles in its effects Myrrh. Acidum 
benzoicum abstracts in its passage through the system 
nitrogen from the elements of urea, being changed into 
hippuric acid, hence its use in urasmic poisoning. Sodii 
Benzoas is more easily soluble and tastes less sharp: 
13.3 = 10.0 Acid. The effect of the Soda on the blood 
is greater than that of Acid, salicyl., and it is the best 
dialytic by inclination to Lithiasis. Natruni benzoicum 



46 CORRECTIVES and ELIMINATIVES: 



99a. 
]J Bismuthi nitrici pr. 

Calcar carbon. IT 5.0. 

Opii 0.25. 

Divide in partes 10. 
j bis die ante cibum. 

Chronic Diarrhoea. 
Vel: 
fy Bism. subnitrici 

Cretae praepar. ^ gr. v. 

Morph sulfuric! gr. 1-6. 
Dentur tales doses 6. 
j tertiis horis. Diarrhoea. 
(in Erysipelas^) 
99b. 
IJ Bism. Subnitratis 3j. 

Sod. Bicarb, gr. v. 

Morphinae gr. 1 6. 
Dentur tales doses 6. 
j tertiis horis. Dysentery. 



99c. 
^ Bismuthi Subnitr. 3j. 

Pulv. aromat. gr. v. 
D. tal.dos. 6 in caps, amylac. 
j post cibum. Pyrosis. 

99d. 
IJ, Bism. subnitrici 

Natri bicarb. T gr. xv. 

Tr. Opii camph. 3 ij. 

Syr. simplicis | j. 

Aquae fontanae § ij. 
3 j tertiis horis. Diarrhoea. 

(3 months). 
Vel: 
IJ Bism. subnitr. gr. x. 

Hydr. c. Creta gr. iij. 

Opii gr. ss. 

Sacchari 3j. 
Divide in partes 10. 
j tertiis horis. (3 months.) 



Bism. Subcarb.: gr. 5 — 30 = 0.32 — 2.0. 
" Subnitras.: gr. 5 — 30 = 0.32 — 2.0. 

and lemonade are quite sufficient to render alkaline 
urine of normal reaction. 

Jn Red Gravel, Acid, benzoic, gr. v— x ter die. In 
Phosphates, Gout, Albuminuria, Incontinence of Urine, 
Laryngitis (chron. with hoarseness) etc., No. 98a, or 
Sodii Benzoas, 0.1 — 1.0 quater die e cyatho aquae — the 
water to assist its dissolving property. In Diphtheria, 
^ ss — 3vj in 24 hours. In Tuberculosis, Magn. ben- 
zoic. 0.15 — 1.0 bihorio vel quartis horis is curative (?). 

Bism. nitricum pr. is very valuable in that form of 
Dyspepsia where the formation of sulfurated hydrogen 
is a prominent symptom. 

In many cases the efficiency of Bism . Praep. is materially 
increased by combining them with Napthol, Salicin and 
other antiseptic agents. See p. 15 et sequelse. 



Acids, Antacids, Expectorants, etc. 



47 



100. 
IJ BlattcT orientalis 

Sacch. Lack 7 0.2— O.G. 
Dentur tales doses 6. 
j ter die. Dropsy. 

101. 
r> Inf. Fol. Buehu 3 viij. 

. (ex 3ij.) 
Daily in divided doses for 
about a week. 

Incontinence of Urine, 
102. 
\\ Cantharid. pulv. 
Scillse Radicis 
Mass. Hydrarg. 7 gr. xij. 
Folior. Digitalis gr. ij. 
F. pilulse 12. 
j bis die. Albuminuria. 



103. 
IJ Carbonis vegetab. 3 j. 

Pulv. aromat. gr. x. 
Divide in partes 6. 
j post cibum. Flatulency. 

104. 
IJ Extr. Cimicif. fl. 3j. 

Aq. Mentha 5 jss. 
3 j ter die. Chorea. 

105a. 
r> ViniColchici 12.0. 

Tr. Opii 2.0. 

Gtt. xx ter die. Gleet. 

105b. 

]J Vmi Colchiei 18.0. 

Tr. Opii crocat. 2.0. 

Gtt. xx — lx tert. vel quartis. 

horis. Asthma. 



Buehu Extr. fl.: 
Cantharides: 

Tr. 
Carbo Ligni.: 
Cimicifuga, Extr. fl.: 
Colcbicum Vinum S. 



3 ss— 3 j 
gr. 1.6—1 
gtt, 4 — 15 
gr. 10—40 
gtt. 15— 3 ss 
gtt, 15— 3 j 



2.0 —4.0. 

0.01—0.065. 
0.13—0.5. 
0.65—2.6. 
1.0 —2.0. 
1.0 —4.0. 



Buehu (Diosma crenulata), or TTva Ursi, as infusion, 
to be taken ad libitum, or Extr. fl. 3 j ter die, is more or 
less valuable in all affections of the genitourinary tract. 

Cantharis (p. 75) is mostly used in diseases of the 
urino genital apparatus, upon which it has a powerful 
influence. At the appearance of strangury or priapism, 
which latter is sometimes very painful and obstinate, it 
must be discontinued and Camphor given, (p. 5.) 

In Albuminuria, to remove the congestion of the kid- 
neys; in Retention of Menses, Tr. Cantharidum gtt. x 
ter die; in Incontinence of Urine from paralysis of neck 
of bladder, the same dose in linseed tea. 



48 CORRECTIVES and ELIMINATIVES: 



105c. 
g, Tr. Colchici Sem. 

" Guayaci ?10.0, 

Gtt. xxx — xl ter die. 
Vel: 

5 Tr. Colchici S. 25.0. 

" Aconiti 10.0. 

" Digitalis 5.0. 

Vinialbi q. s. adlOOO.O. 

8 c. c. bis die. Rheumatistn. 

105d. 
# Tr. Colchici S. 3 ij. 
Kalii iodati 3 ss. 
Aq. destillatse | iij. 
| ss ter die. Neuralgia, 



106a. 
5 Copaivae 3 iij. 
Mucil. Acaciae ? j. 
Tr. Ferri chlor."3ij. 
Aq. Fontis ad § viij. 
1 ss — | j ter die post eibum. 
Gonorrhoea. 
Vel: 

r> Copaivae 50.0. 

Alcoholis 10.0. 

01. Menth. pip. 0.5. 

Gtt. xl — 1 qnater die ex 

aqua saccharata. 

Gonorrhoea, 
(if chronic.) 



Colchic. 


Extr. 


fl. 


gtt. 


5- 


-20 = 


0.2- 


-0.65. 


a 


Tr.: 




gtt, 


15- 


"3j = 


0.5- 


-4.0. 


Copaiva 






gtt. 


15- 


-3j= 


1.0- 


-4.0. 



Colchicum is by no means a true diuretic — its action 
on the kidneys being no greater than it is on the skin, 
liver and mucous membrane; but it has a decided anti- 
arthritic influence, not only on account of its diminishing 
the uric acid in the urine, but also probably arresting 
fermentation of this acid in the blood. Its effect should 
be watched as it produces in too strong doses Gastritis, 
bloody stools, etc., with great nervous excitement. (See 
p. 5.) It is generally administered till an effect is pro- 
duced on the bowels, unless it is desirable to act more 
on the skin, when it must be combined with Opium. 

Copaiva acts analogous to the Terebinthinates, stimu- 
lating the secretions from the mucous membrane. It is 
almost exclusively used in Gonorrhoea and will act here 
under proper directions to a certainty. Though of 
benefit in painful hemorrhoidal affections and the chronic 
form of Bronchitis, Diarrhoea and Dysentry, it is seldom 



Acids, Antacids, Expectorants, etc. 



49 



106b. 
IJ, Copaivae 3 ij — 3 iij. 
Liq. Potassae | ss. 
Tr. Aloes comp. 3 ij. 
Aquae fontanae ad 3 viij. 
I j ter die post cibum. 

Gonorrhoea. 
Vel: 

3 Copaivae 3 ij — 3 iij. 
Pepsin, in frust. 3 ss. 
Aq. Fontis ad § viij. 
§ j ter die post cibum. 

106c. 
IJ Copaivae 30.0. 

Chloroformii 3.0. 

Tr. Ferr. acet. aeth. 10.0. 
Gtt. xl— 1 ter die. 
Vel: 

PJ Copaivae 25.0. 

Tr. arom. acidae 5.0. 
Gtt. xv — xx quater die. 



Vel: 

I£ Copaivae 

01. Terebinth. " a 3 ij. 
Gtt. xx quater die. Cystitis. 

107. 
I£ Cretae praep. gr. xij. 
Calomelanos gr. vj. 
Opii gr. j. 
Divide in partes 12. 
j bis die. Dysentery. 

(6 months.) 
Vel: 

r> Pulv. Cretae comp. gr. ij. 

" Cretae comp. cum 

Opio gr. j. 

After each stool, or every 

hour. (1 year.) 
(3 years: double the dose — 
5 years: treble — 10 years: 
treble every half hour.) 

Diarrhoea. 



Creta Mixt.: 
" Pulv. co.: 



gr 



3 ss ~ 
, 15- 



3j = 



16.0—32.0. 
1.0— 4.0. 



employed on account of its horrible taste. LiquDr 
Potassae and Pepsin emulsify it; but if combined with 
vegetable or mineral styptics, Acacia must be used for 
that purpose. Combined with 01. t?rebinthinae (in 
Cystitis) it makes the alkaline urine soon sour. The 
best way of taking Copaiva is to swallow two or three 
capsules before a meal, or at bedtime, and to take the 
other ingredients of the mixture separately. 

Pulv. Cretoecomp.: Creta, 1^; Acacia, 1; Sacchar. p. 2\. 

Pulv. Cretw cornj). c. Opio: 2>ij =gr. j. 

Mixt. Cretce: Pulv. Cretae comp. 3j; Aq. Fontis 3 j. 

In Vomiting of Pregnancy: Aq. Calcis cum Lacte. 



50 CORRECTIVES and ELIMINA TIVES: 



108a. 
5 Tr. Digitalis 

Vini Colch. Sem. ^ 3 ij. 
Kali nitrici 3 j. 
Roob Juniperi § j. 
Aq. Fontis ad § viij. 
3 j bihorio. Dropsy. 

Vel: 

fy Tr. Digitalis 3 ij. 
" Scillse 
Syr. Aurant. C. "i 
Mixt. Camph. ad 
| ss ter die. 
Vel: 

r> Tr. Digitalis f ss. 
" Apocyni § j. 
Aquae Fontis ad | 
| j quater die. 



ij. 



"]• 



Vll]. 



108b. 
$ Tr. Digitalis 

Vini Colchici S. 7 10.0. 
Spir. muriatico-aeth. 2.0. 
Gtt. xx quartis horis. 

Hydrothorax. 
109. 
5- Inf. Folior. Jaborandi 

(ex 10.0) 200.0. 
Pars semis at once; of the 
rest | ss hourly with as 
much wine. Poisoning 
by Atropin. 
110a. 
5 Lith. benzo-salicyl. 3 jss. 
Extr. Hydrang. fl. | ij. 
Aq. fontanae § vj. 
3 i j ter die. Hcematuria. 



Digitalis: 



gr. f— 2 =0.032 
" Extr. fl. gtt. 5—40 =0.18 - 

" Tr.: gtt. 10—80 =0.32 —2.6. 

Jaborandi Extr. fl.: gtt. 15 — 3 j=1.0 — 4.0. 

Pilocarpin: gr. 1-30—^=0.002—0.02 



■0.13; i-P p<» 
1 3 m ' 



Digitalis (p. 78), slows the pulse and is occasionally 
valuable in Spasmodic Neuralgia, Genital Irritation and 
Insanity. The tincture may be given in 3 ss doses in 
delirium of Typhoid. 

Jaborandi usually produces after 10 minutes adminis- 
tration profuse ptyalism, nausea and diaphoresis. Its 
antidotal power (No. 109) is based upon the fact that 
it slows the heart's action by stimulating the same ner- 
vous apparatus which is paralyzedby BeIladonna,namely, 
the intra-cranial inhibitory apparatus. Pilocarpin some- 
times causes headache, vomiting, singultus, dysuria, cold 
extremities and collapse. Duboisin, Atropin and Daturin 
are the antidotes; secretions of skin and contraction of 



Acids, Antacid*, Expectorants, etc. 



51 



110b. 
IJ Lith. benzo-salicyl. 3jss. 
Extr. Gelsem. fl. gtt. x. 
;< Hyoscyami fl. 3 ij. 
" Hydrangeas fl. \ ij. 
(Pot. brom. § ss.) 
Aq.Fontis ad § viij . 
3 ss quartis horis ex aqua. 
Cystitis. 
110c. 
IJ Lithii citrici 4.0. 

Glycerini 30.0. 

4 c. c. bis die. Gout. 

Vel: 

IJ Lithii Citratis 3j. 
(Tr. Colchic. S. 3j.) 
Aquae f on tame 3 vj. 
3 ss bis vel ter die ex aqua. 



Ilia. 
IJ Magn. carbon, f ss. 
Spir.Lavand. comp. 3 jss. 
Olei Carvi gtt. vj. 
Aq. fontanie 3 jv. 
3 j subinde. Diarrhoea. 

111b. 
IJ Magnes. carbon. 3 ss. 
Extr. Rhei. fluidi 
Spir. Aram, arora. a 3 ij. 
Aq. Fceniculi ad 3 jv. 
3 j bis vel ter die. ZharrAo a. 

112a. 

IJ Magn. usta3 10.0. 

Aq. fontanae 100.0. 

Glycerini 40.0. 

16 c. c. every 15 — 30 rain. 

Poisoning by acids, etc. 



Lithii Carb.: gr. 2 — 8 = 0.13—0.5. 

« Citras: gr. 2— 8 =0.13—0.5. 
Magn. carb.: gr. 15 — 3 ij = 1.0 — 8.0. 

" usta: gr. 15— 3 j = 1.0 —4.0. 



pupils are stopped at once (see Hyoscyamus, p. 33). 
Pilocarpin is advantageously used in Uraemia of Ty- 
phoid, if hydragoguea are contra-indicated by abdom- 
inal symptoms; but it should not be employed in heart 
and lung diseases; nor in hydrops of pregnants. 

In Ascites: Extr. Jaborandi fl. 3 j hora somni. In 
Neuralgia, Nervi Quinti, 3 ss — 3j before the expected 
return of the fit. In Urremia of Typhoid and Perni- 
cious Intermittens, Pilocarpin hydrochlor. gr. \. 

Lithium : The salts of Lithium are double the strength 
of those of Potassium. As Litholyticum: Lithium ben- 
zoicumO.l — 0.2 tertiis horis; Lith. carbonicum 0.2 — 0.5 
ter die (1.5 per diem). 



52 CORRECTIVES and ELIMINATIVES: 



112b. 
5 Magn. ustse gr. vj. 

Aquae Fontis | jss. 
3 j ter die. Stomatitis. 

(8 months.) 

113a. 
]J Tr. Opii camph. § ss. 
Extr. Scillae fl. 3 j. 
Mueil. Acacia 5 ij. 
Syr. Pruni Virg. § j. 
Aq. fontanae ad § vj. 
^ ss subinde. Bronchitis. 

113b. 
IJ Tr. Opii camph. 3 ij. 
(Amnion, chlor. 3j.) 
Extr. Bellad. fl. gtt. ij. 
" Ipecac, fl. gtt. jv. 
Aq. Laurocerasi 3 j. 
" Anisi ad § jv. 
3 ij tertiis horis. (3 years.) 



114. 
IJ Extr. PareiraB fl. § j. 
Spir. Junip. comp. § ij. 
Acidi benzoici 3 j. 
Morphii sulfurici gr. j. 
3 j ter die. Irritable 

Bladder. 

115. 

3 Picis liquid, pulv. 20.0. 

Vini Hispanici 1000.0. 

Sepone interdum agitando 

per diem, turn filtra. 
| j pro dosi. 

Chron ic Br on chitis . 

116. 

B.Tr.Pimpinellae 20.0. 

Syr. Morphini 

Aq. Melissae 7 100.0. 

3 ij tertiis vel quartis horis. 

Hoarseness, 



Pareira Extr. fl. : 3 ss — 3 j 
PimpinellaTr. gtt. 20— 3 j 



2.0—4.0. 
1.0—4.0. 



Lithii Citras 10.0 = Acid. citr. 9.6 andLith. carb. 5.3. 
The average dose is from 0.5 — -1.0 ter die. Both the 
Carbonate and Citrate are very valuable in Gout, from 
the fact of their low combining power, and the great 
solubility of the Urate of Lithium, thus enabling them 
to eliminate easier the uric acid from the system. They 
are best given largely diluted, and the Carbonate in 
Carbonic acid water. 

Magnesia is a favorite laxative for infants — its com- 
bination with Rhubarb is known in Germany as Infant's 
powder par excellence. See section VI. 

Pareira is an excellent remedy in chronic diseases of 
the urinary passages, particularly chronic Inflammation 
of the Bladder; it is also slightly aperient. 

Pix liquida pulv. =Pix liquida p. 1; Carbo Lignip. ij. 



Acids, Antacids, Expectorants, etc. 



53 



11 7a. 

IJ Pot. Acetatis |bs. 

Tr. Rhei 3 x. 

Vim stibiati 3 ij. 
Gtt. v — x ter die. (To in- 
crease to 30.) Rickets. 
117b. 
IJ Kali acetici 5.0. 

Oxym. Scil he 

Syr. simplicis ^ 15.0. 

Aq. Petroselini 125.0. 
16 c. c. biborio. Diuretic. 

118a. 
IJ Liq. Potassa* 

Spir. nitrico-aeth. 1 3 ij. 

Extr. Gent. comp. fl. 3 ss. 
vel Tr. Gent. comp. § ss. 

Aq. fontanae \ v j« 
3 j ter die. Gardialgia. 



118b. 
IJ Kali carbonici 3 j. 
Spir. nitrico-aeth. 3 ij. 
Tr. Oinnam. comp. |bs. 
Inf.Gent.comp.ad 3 viij. 
3 ssterdie. Ovar. Dropsy. 

11 fa. 
IJ Pot. Bicarb. 3 ij. 
vel Liq. Potasc 

Extr. Hyoscyami fl 3ss. 
vel Tr. Hyoscyami 3iij. 

Mixt. Camphor, ad 3 viij. 
3 j ter die post cibum. 

Red Gravel. 
119b. 
IJ Kali biearbonici 3j**. 
Amnion, carbonici 3 ss. 
Aquae fontanae 3 vj. 
3 j bis die. Antilithic. 



Potass. Acetas: gv. 5—30 = 0.32—2.0. 

" Liquor: gtt, 5—30 = 0.32—2.0. 

« Carb. gr. 5 — 30 = 0.32—2.0. 

" Bicarb.: £r. 5—30 0.3 2 — 2.0. 



Potassii Acetas (Kali aceticum) like all alkaline salts 
containing a vegetable acid, is changed in the stomach 
into a carbonate, and eliminated by the kidneys, making 
the urine usually alkaline. In large doses a gentle 
cathartic, it is in small ones diuretic, increasing the 
flow of urine, yet diminishing both the uric acid and 
urea, hence it prevents more or less the formation of 
uric acid calculi. It is much employed in acute Rheu- 
matism and Dropsies; and it has also been found useful 
as an alterative in cutaneous affections. 

Salts of Potassium or Sodium used as antacids (with 
vegetable tonics) in Dyspepsia, accompanied with excess 
of acid in the primae viae, promote the digestion of fatty 



54 C0RBEC1IVES and ELIMINATIVES: 



9 



119c. 
Pot. Bicarbonat. 3 j. 

" Iodidi gr. xij. 
Aquas destillatse § vj. 
| ss bis die. Bronchitis. 

119d. 
§, Kali bicarbonici 
Spir. Amm.arom.a 3 j. 
Aq. destillatse § jv. 
§ j ter die cum Acidi citrici 
gr. 1 5 antea in Aqua solut. 
Chron. Vomiting. 
120a. 
^ Sod. Bicarb. 3 iij. 

Spir.Lavand. comp. 3 ss. 
Aq. destillatse § vj. 
5 ss tertiis vel quartis horis. 
Jaundice. 



Vel: 

5 Natri bicarb. 3 ij- 

Rad. Rhei 3 ss. 
Cort. Cinchona3 1 j. 
F. pulvis. 3 j ter die. 

120b. 
IJ Sod. Bicarbonatis 3 j. 
" Nitratis 3 ss. 
Aq. fontanse § iij. 
3 j omni hora. 
(4 years.) Diphtheria. 

120c. 
5 Natri bicarbonici gr. x. 
Ferri c. Saccharo 
Bism. subnitr.1Tgr.viij. 
D. tal. dos. 6 in caps. amy], 
j ter die post cibum. 

Endocarditis. 



Sod. Bicarb.: gr. 5—60 = 0.32—4.0. 

matter. Their action in Gout and acute Rheumatism 
depends also on the neutralization of the excess of acid 
with which the blood is charged. By neutralizing the 
acid, the alkalies relieve also the irritability of the 
urinary organs; hence their use in Ardo Urinse accomp- 
anying Gonorrhoea, Pruritus Ani, Uterine and Cutane- 
ous Irritation, etc. The preparations of Sodium are less 
irritating and less depressing than those of Potassium; 
and though they are inferior as antilithics, being less 
powerful solvents of uric acid, they are better antidys- 
peptics. 

In the treatment of Red Gravel, etc., the exhibition 
of the alkalies should be but sufficient to neutralize the 
urine; for, if it be made alkaline, the phosphate formed 
may be deposited around the uric acid calculi. 

Liquor Potassce is more irritant to the stomach than 
Pot. bicarb.; therefore less eligible for protracted use. 



Acids, Antacids, Expectorants, etc. 



55 



121a. 
3, Pot. Chloratis 3 ij. 

Acid.hyd^ochlor. d. 3 ss. 
Syr. simplicis 3 j. 
Aq. fontana3 | v. 
I ss — 3 j quartis horis. 

Bronchitis. 

121b. 

IJ Kali chlorici 10.0 

" nitrici 5.0 

Extr. Hyoscyami 1.0 

Syr. simplicis 30.0 

Aq. Fontisq s. ad 200.0 

5 ss bihorio T^^r. Diseases. 



121c. 
5 Pot. Chloratis 3ij. 
Tr. Ferri Chlor. 3j. 

" Digitalis 3 ss. 
Aq. fontanaa § iij. 
3 ij bihorio. Scarlatina. 
(4 years.) 

122a. 
IJ Kali. nitr. 3>ij — 3 j. 

Tr. Aconiti gtt. iv. 
vel Tart, emetic, gr.ij. 

Aq. Melissa? 3 jv. 
3 ss tertiis horis. 

Pleuritis. 



Pot. 



Sod. 



Chlor.: 
Citras: 
Nitras: 
Boras: 
Nitras: 



g 1 '- 
g r - 
g r - 
g r - 
g r - 



5—30 = 0.32— 
3—30 = 0.2 — 
3 — 20 = 0.2 — 
2—20 = 0.13— 
10—40 = 0.65— 



2.0. 
2.0. 
1.3. 
1.3. 
2.6. 



Potassii Carbonas (Kali carbonicum) is especially 
useful in torpor of the liver. 

Sodii Bicarbonas (Kali bicarbonicum) in large doses 
— 3 j — 3 iij p. diem — should not be used for more than 
ten consecutive days, to avoid superalkalinity of the 
blood. From 3j — 3 ijss, followed by Acid, tartaricum 
gr. xv — 3v areused as a diagnostic test in dilatation of the 
stomach. Borax, which is also a mild refrigerant, is 
chiefly used for its emmenagogue properties. 

Potassii Citras (Kali citricum) is an excellent refri- 
gerant, and generally given as Potio jRiceri: Pot. bicarb, 
and Acidum citricum a 1.0 separately dissolved in a 
little water. To be mixed and taken with sugar water 
as an effervescing draught. (In Vomiting of Pregnancy.) 

In defective Menstruation: Borax, 0.5 — 1.5. In Dia- 
betes Mellitus: Sod. bicarb. 3jper diem, to be increased 
to 3 iij daily for about a week in each month. In artic. 



56 CORRECTIVES and ELIMINATIVES: 



122b. 
IJ, Kali nitrici 

" bicarb. ^ 3 j. 
Aq. Amygd. am. c. 3 ij- 
Aq. fontanae § vj. 
§ sstertiis horis. Bronchitis. 

122c. 

^ Pot. Nitratis 2.5. 

Sod. Nitratis 5.0. 

Succi Liquiritiae 8.0. 

Aq. Foeniculi 155.0. 

3 ij omni hora. 7 — 9 years. 

( 3 j bihorio 1 — 3 years.) 

Febrile Diseases. 
122d. 
5 Pot. Nitratis 

Aq. Laurocerasi ^ 7.5. 
(Extr. Hyoscyami 0.4.) 
Syr. Papaveris 30.0. 
Aq.Fontisq. s. ad 250.0. 
| ss omni hora vel bihorio. 
Gonorrhoea. 



122e. 
U Potass. Nitratis 

Succi Glycyrrhiz. ^ 7.5. 

Extr. Hyoscyami 1.0. 

Liq. Amm. anisati 15.0. 

Aq. fontanae ad 250.0. 

16c.c. bihorio vel tertiis 

horis. Bronchitis. 

Vel: 

r> Kali nitrici 

Kalii iodati IT 3 j. 
Extr. Senegae fl. 3 ij. 
Syr. tolutani 3 j. 
Aq. Anisi ad \ vj. 
I ss ter die. Emphysem. 

123a. 
fy Kali nitrici 3 ss. 
Tr. Digitalis gtt. xx. 
Aq. fontanae § iij. 
I j tertiis vel quartis horis. 
Abortion. 
(If feverish and plethoric.) 



Rheumatism (acute), Sod. vel Potass, bicarb. 3 j — 3 ij 
bihorio vel tertiis horis until urine alkaline. 

Potassii Chloras (Kali chloricum) 0.5 as dose. See 

Iodine, section 1. 4 — 8.0 p. diem for adults. 2.0 p. 

diem: (3 years;) 1.25 infants; in Stomatitis: (3j) | iij 

3 ij bis vel ter die. (8 months); in Scarlatina: 3 j to Oj 

of water as drink during the day. (4 years.) 

Potassii Nitras (Kali nitricum) is a valuable refriger- 
ant and sedative in fevers; in doses of gr. x — 3 ss it is 
diaphoretic and diuretic. See Salicin p. 17. In doses 
of 10.0 — 20.0 it may cause death. Sodii Nitras (Natrum 
nitricum) is milder, and much used as drink, especially 
in Dysentery: § ss— §j per diem in a mucilaginous 
vehicle. Sodii Nitris (Natrum nitrosum — No. 60c.) is 
seldom employed as a remedial agent. 



Acids, Antacids, Expectorants, etc. 



57 



123b. 
IJ Potassii Nitratis 

Tr. Digitalis a 3j. 

Aq. Melissre 3 jv. 
3 ss tertiis horis. Pleuritis. 
(if effusion.) 
123c. 
IJ Pot. Nitratis 3j. 

Tr. Digitalis 3 ij- 

Aq. f on tan re 3 vj. 
3 ss eextis horis. Dropsy 
(5 years.) from Scarlatina. 
Vel: 
IJ Pot. Nitratis 3j. 

Tr. Digital. 3j. 

Spir. nitrico-aeth. 3 ij. 

Syr. simplicis 3 j. 

Aq. fontanse ad 3 viij. 
3 ssbihoriovel tertiis horis. 
(4 years.) 



124a. 
IJ Kali nitrici 3 ss. 

Pulv. Doveri gr. xxjv. 
Divide in partes 6. 
j qtiartis horis until diapho- 
resis. Ascites, 
(12 years.) (from cold.) 

124b. 
IJ Kali nitrici 

" sulf.a 0.5— 1.0. 

Pulvis temperans. (More 

than 3.0 are objectionable.) 

EfXciti nu rU 

from fright, 

125a. 

IJ Xatri phosphorici 50.0. 

" bicarbonici 5.0. 

Aquce Fontanae 600.0. 

During the day with Acid. 

citr. 5.0. Rheumatism. 



Sodii Phosph. : 3 j— 3 j = 4.0—32.0. 

In acute articular Rheumatism, Pot. nitr. gr. v quartis 
horis; vel Sod. Nitras 1.0 — -°>.0 bihorio vel tert. horis. 
(The same dose of the latter salt in Dysentery.) In 
Cholera Infantum and Scrofula: Solutio Xatri nitrici(l 0.0) 
40.0 — 3 ij omni hora vel bihorio ex aqua. In febrile 
diseases of children, Sol. Kali nitrici (gr. x) 3 ij with 
Tinctura Aconiti gtt. j: 3 j bihorio; infants should have 
half this dose. 

Sodii Phosphas (Natruni phosphoricum) is mostly 
used on account of its laxative property. See section vi. 
In Gravel: 2.0 — 6.0 ter die; vel Sod. phosph. ammon. 
gr. x ter die. 

Sodii CMoridum (Xatrium chloratum 3 j — 3 j during 
intermission is said to cut sometimes the fever in 
Intermittens. (See page 101.) 



58 CORRECTIVES and E LIMITATIVE S. 



125b. 
^ Sodii Phosphatis 10.0. 
Acidi benzoici 1.5. 

Aq. fontange 180.0. 

In 5 doses during the day. 
Gravel. 
126a. 
g, Scillse pulv. gr. iij. 
Opii gr. ss. 
Cinnamomi gr. x. 
Dentur tales doses 6. 
j bis die. Cardiac Dropsy. 



126b. 
£} Extr. Scillse fluidi 

" Ipecac, fl. ^ gtt. x. 
" Bellad. fl. gtt. j. 
Aq. Laurocerasi gtt. xv. 
Syr. Acacise 
Aq. Anisi~ \\. 
3 ss omni hora. Cough. 
(5 weeks.) 

127. 
t> Extr. Toxicod. fl. 3 j. 
Gtt. ij ter die. Neuralgia. 



Scilla: gr. 


1—3 = 0.065—0.2. 


" Extr. fl.: gtt. 


2—10 = 0.065—0.32. 


« Tr.: gtt. 


10—60 = 0.32 —2.0. 


Toxicod. Extr. fl.: gtt. 


1_10 = 0.032—0.32. 



Scilla promotes, in small doses, secretions from the 
mucous membranes and the kidneys — its diuretic effect 
being much the most marked. In large doses it excites 
nausea and vomiting, accompanied sometimes by purg- 
ing; and in excessive doses it acts as acro-narcotic poison 
— 24 gr. having proved fatal. In cardiac dropsies it 
is generally combined with Digitalis; and Calomel is 
often added with a view to its action on the absorbents. 
It is, however, contra-indicated in cases complicated 
with degeneration of the kidneys or inflammation of the 
bladder; nor should it be used in inflammatory bron- 
chial affections, though it is an excellent expectorant in 
chronic cases. 

Acetum Scillce =1:10 Acidum aceticum dilutum. 

Syrupus Scilloe = Acetum p. ij, Sacharum p. iij. 

Rhus toxicodendron is sometimes used in Chronic 
Eczemata, Gout and Amaurosis. It is, however, little 
reliable, and its effects have to be closely watched. 



SECTION IV. 



ASTRINGENTS 

Suspend the ex- and secretions of the various organs, 
or restrain profluvia or hemorrhage, by producing con- 
traction of the muscular fibre, or by coagulating the 
albumen of the blood. 

Acidum gallicum: Astringent. 

Acidum sulfuricum dil. i Astringent, Refrigerant, 
Antiphosphatic. 

Acidum taxxicum: Astringent. 

Agaricus: Astringent. 

Alumex: Astringent, Antispasmodic, Antiseptic. 

Argextum: Astringent. 

Capsella bursa pastoris: Astringent. 

Catechu: Astringent, Tonic. 

Cinxamonum: Astringent, Aromatic, Stimulant. 

Coto: Astringent. 

Creosot.: Astringent, Antiseptic, Antiscorbutic. 

Cuprum: Astringent, Anticonvulsive, Tonic, Emetic. 

Ergota: Astringent, Oxytocic. 

Erigerox t : Astringent, Diuretic, Tonic, Stimulant. 

Ferrum: Astringent, Tonic. 

ELemamelis: Astringent, Sedative. 

Krso : Astringent. 

Macis: Astringent, Aromatic. 



60 ASTBINGENTS. 

Plumbum: Astringent, Sedative. 
Ratanha : Astringent. 
Rhus aromatica: Astringent. 

Terebinthina: Astringent, Expectorant, Anthel- 
mintic. 
"Ova ursi: Astringent, Diuretic, Stimulant. 



ASTBINGENTS. 61 

128a. 128c. 

IJ, Acidi gallici gr. v. $ Acidi gallici 3j. 

Opii gr. ss. Extr. Cannab. Ind. gr.v. 

Dentur tales doses 4. F. pilulse 5. 

j tertiis vel quartis horis. j hora somni. Sweats. 

Hemoptysis. ( Colliquative.) 

128b. 129a. 

5 Acidi gallici gr. xv. IJ Acidi sulf. dil. 3 ij. 

Tr. Hyoscyami 3j. Syr. Aurant. C. |j. 

Aquae fontanse § iij. Aq. Fontis ad § viij. 

|j ter die. Hematuria. |j ter die. NigJit-siceats. 



Acidum gallicum: gr. 5 — 20 = 0.32 — 1.3. 

" sulf. dil.: gtt. 10—30 = 0.75—2.3. 

" " arora.: gtt. 10— 30 = 0.75 — 2.3. 

Elix. acid. Halleri: gtt. 2—15 =0.15— 1.0. 

Acidum gallicum given by the stomach, is more 
efficacious than Tannin. Gr. jv. — vj in pill quartis vel 
sextis horis in Albuminuria, Diabetes, Hemorrhage 
from Carcinoma, etc. 

Acidum sulfuricum dilutum is chiefly used in Typhoid, 
Colliquative Perspirations, Cholera and Choleric Diarr- 
hoea; and it is the best corrective for Phosphatic Lithi- 
asis. As astringent it is given from gtt. xx — xxx ter 
die ex aqua; and it should be sucked through a glass 
tube, to prevent injuring the teeth. [Acidum sulfuricum 
aromaticum — Tr. aromatica acida — is more agreeable to 
take. See sections in. and v.) In Gastritis, gtt. xv ter 
die ex aqua; in Purpura gtt. v — xv bihorio; and in Lead 
Colic it may be given as lemonade — 3 j in sugar water 
Oj during the day. 

Acidum sulfuricum aromaticum: Alcohol 3 xjv. 
adde gradatim Acidi sulfurici 3 ij. 

Post refrigeration em adde Tr. Zingiberis 3 j; 

01. Menth. p. gtt. j; Alcohol, q. s. ut f. | ijss. 

Elix. acidum Halleri — Acid, sulfur, pars j; 
(Mixt. sulf. acida.) Alcohol, partes iij. 



62 



ASTRINGENTS. 



129b, 
IJ Acidi sulf . diluti 

Extr. Ergotse fl. 7 3 ij. 

Aq. fontanae ad § viij. 

1 j ter die. Metrorrhagia. 

129c. 
]J Acid. sulf. dil. 3 ij. 
Tr. Cinnamomi | j. 
Syr. Aurant. C. 3 ij. 
3 j ter die. Chlorosis. 

130a. 
^ Acidi tannici 

" benzoici ^ 3j. 
Sacchari albi 3 j. 
F. pulveres No. 20. 
j bihorio. Pertussis. 

(3 years.) 

130b. 
5- Acidi tannici gr. vj. 
Extr. Bellad. fl. gtt. jv. 
" Conii fl. gtt. xv j. 
Syr. Flor. Aurant. § ij. 
Aq. fontanse § vj. 
3 ij bihorio vel tertiis horis. 
(3 years.) Pertussis. 



131. 
§- Agaricin gr. j. 
Extr. Hyoscyami 
Rd. Althcfeae ^ gr. iij. 
F. pilule 6. Consperguntur 
Pulvere Cinnamomi 
j vel ij hora somni. 

JVight-siceats. 
Phthisis. 
132a. 
g, Aluminis 3 jss. 
Aquae Fontis § v. 
Syr. simplicis | j. 
I ss bis die. Menorrhagia. 

132b. 

^ Aluminis 3 ss. 

Aq. Melissae 

Syr. simplicis a § ij. 

3 j tertiis vel quartis horis. 

(3 years.) Pertussis. 

132c. 
5 Aluminis 0.4. 

Opii 0.03. 

Dentur tales doses 5. 
j bis vel ter die. Diarrhoea. 



Acid, tannic: gr. 2- 
Agaricin: gr. 1-12- 
Alumen: gr. 8- 



-10 = 0.13 —0.65. 
. ■§.= 0.005—0.032. 



-30 



0.5 —2.0. 



Tannin. It is believed that, owing to its coagulating 
influence on albumen, it is not absorbed in the stomach, 
and cannot produce constitutional effects, until converted 
into gallic acid — hence, given by the stomach this is 
preferable; — but the gallic acid is probably again 
changed in the blood into Tannin by combining with 
Glucose. In Nightsweats, Tannin gr. ss — ij hora somni; 
in atonic Menorrhagia gr. ij tertiis horis in pill. 



ASTBINGENTS. 



63 



132d. 


134b. 


IJ Aluminis 3j — 3 ij. 


IJ, Tr. Caps. Bursae Past. 


Tr. Opii gtt. xl. 


Syr. simplicis a 3 j- 


Syr. simplicis 3 ij. 


Extr. Uvae Ursi fl. 


Aquae Fontis § vj. 


< Scutell. fl. 7 3 ss. 


| jtertiishoris. Leac/ Cbftc. 


3 ss ter die ante cibum. 


133. 


Same. 


5, Argenti nitrici gr. ss. 


135a. 


Aq. Cinnamomi § iij. 


IJ Catechu 40.0. 


Syr. Flor. Aurantii § j. 


Cort. Cinchonae 20.0. 


3 j quartis horis. Diarrhoea. 


Pulv. aromatici 10.0. 


{non-inflammatory.) 


3 j ter die. JPulvis 


(3 years.) 


Ebriosorum. 


134a. 


135b. 


r> Tr. Caps. B. Past. | ss. 


IJ Catechu gr. xv. 


Elix. simplicis 3 jss. 


Pulv. Cretae comp. cum 


3 j ter die. Enuresis 


F. pulvis Opio 3j. 


nocttcrna. 


After each stool. Diarrha a. 


Argenti Nitras: gr. £ 


— 1 = 0.015—0.065. 


Catechu: gr. 10 


—30 = 0.G5 —2.0. 



Alumen is a powerful astringent; in large quantities 
the astriction may be followed by vomiting and purg- 
ing; even inflammation will set in. To prevent 
nausea it may be combined with aromatics; but it is 
perhaps most palatable in the form of whey, prepared 
by boiling 3 ij with milk Oj and straining. (Dose 3 ij.) 
In Gastralgia: Alum. gr. x ter die in caps, amy lac. 
{Astringents, mineral and vegetable, when used to check 
morbid discharges from the bowels, are better combined 
with Opium, as they do not restrain the peristaltic 
movements of the intestines without the latter.) 

Gapsella Bursa Pastoris is a very popular remedy in 
some parts of Germany for diarrhoea and almost all forms 
of hemorrhages. About 25.0 of the fresh, or 10.0 of the 
dried herb to one pint of water as tea, which is to be 
taken in 3 doses at intervals of two or three hours. 



64 



ASTBINGENTS. 



135c. 
]J Tin ct. Catechu 3 j. 
" Ratanhae 3jss. 
" Opii gtt. xv. 
Mixt. Cret. comp. § jss. 
After each stool. Dysentery. 
135d. 

r> Tr. Catechu 

" Ratanh.'Jgtt.x — 3j. 
Mixt. Cretae comp. § ij. 
3 j bis vel ter die. 

Diarrhoea Ablactator. 
136. 
3 Tr. Cinnamomi 

Elix. simplicis ? § j. 

Tr. arom. acidae 3 j. 

3 j ter die. Palpitation. 

137. 

$ Cotoinae 0.05—0.08. 

vel Paracotoin. 0.15 — 0.25. 

Alcohols dil. 10.0. 

Glycerini 30.0. 

Aq. destillatae 120.0. 

| ss omni hora vel bihorio. 

Diarrhoea, 



138a. 
3, Creosoti gtt. vj. 

Saponis med. J)j. 
F. pilulae 6. 
j after each vomiting. 
Vel: 
fy Creosoti gtt. vj. 

Acid, acetici dil. 3 j. 

Aq. fontanae § vj. 

3 j bihorio vel tertiis horis. 

138b. 
g, Creosoti gtt. x. 
Acaciae 3ij. 
Aquae Fontis § jv. 
1 j fcextis horis. Dysentery. 

138c. 
5- Creosoti 5.0. 

Alcoholis 20.0. 

Glycerini 225.0, 

4 c. c. ter vel quater die. 

Tuberculosis. 
138d. 
]J Creosoti gtt. j. 

Syrupi Acaciae 5 j. 
3 j bihorio. Vomiting. 

(1 year.) 



Catechu Tr.: gtt. 20— 3 j = 1.0 —4.0. 
Cinnamom.: gr. 10 — 20 — 0.65 — 1.3. 
" Tr. gtt. 20— 3 j = 1.0 —4.0. 

Coioina: gr. 1—3 = 0.065—0.2. 

Creosot: gtt. 1—3 = 0.065—0.2. 

Cinnamonum is more of an aromatic stimulant than 
astringent, and chiefly used for its flavor. 

Creosot is an efficient remedy in Gastric Irritation and 
Haematemesis. In chronic Bronchitis, Creosot. 0.1 — 0.4 
per diem in Malaga or 01. Jecoris is excellent; but it has 
to be used for a long time. 



ASTRINGENTS. 



65 



Vel: 

IJ Aq. Creosoti § ij. 

JEtheris gtt. x. 

Syr. simplicis \ j. 
3 ij ter die. Cholera 

(3 years.) Infantum, 

139. 
IJ Cupri sulf. gr. v — x. 

Opii gr. x. 
F. pilulae 10. 
j ter die. Dysentery. 

140a. 
IJ Ergote pulveratse 

Cinnamomi 20.5. 

Dentur tales doses 5. 
j every 10-15 min. ex aqua. 



Vel: 

IJ Secalis cornuti 

Elaeosacch. Chamomili. 
Boracis T0.5. 

Pulvis obstetricus. 
140b. 
IJ Extr. Ergotoe 1.0. 

Tannini 2.0. 

Aq. fontanel 225.0. 

1 ssoainihora. Hematuria. 
Vel: 

IJ Extr. Ergote fl. 3 ij. 
" Digitalis fl. 
" Ipecac, fl. 2 3 j. 
3 ss — 3 j pro dosi. 

Haemoptysis. 



Cupri Sulphas: gr. J — 10 == 0.015 — 0.65. 
Ergot. Extr. fl.: gtt. 10— 3 j = 0.32 — 4.0. 
" Tr. 3j— 3iij=4.0 —12.0. 

Ergotina: gr. 3 — 10 = 0.2 — 0.65. 



Cuprum (pp. 77 & 100) is occasionally of great 
benefit in some of the most obstinate forms of diarrhoea, 
and it is said to be a sure ta?nicide. See section vin. 

Ergot (Secale cornutum) is used in all kinds of hem- 
orrhages: in Dysmenorrhea, and to expel hydatids or 
polypi from the uterus; it is also valuable in Paralysis of 
the bladder. Being a most reliable oxytoxic its chief 
use is in midwifery, especially after delivery, to prevent 
flooding, etc. If taken too much it produces Ergotism, 
which assumes two forms, one attended with convul- 
sions, the other with dry gangrene on the limbs. 

In Diabetes Insipidus: Extr. fl. 3 j ter die; in Pulmon- 
ary Hemorrhage, 3 j — 3 ij omni hora vel media hora si 
opus est; in hemorrhage from Subinvolution, Hyper- 
plasia, Soft Engorgement, with profuse menstruation, 
Polypi, etc., Tr. 3 j ex aqua bis vel ter die. 



66 



ASTBINGENTS. 



141. 
Ijt Extr. Erigerontis fl. 3 ij. 

Elix. simplicis ad | ij. 
3 j ter die. Incontinence 
of Urine. 
142. 
IJ, Tr. Ferr. acet. seth. 25.0. 
" Cinchona 50.0. 

Acidi citrici 3.0. 

Glycerinse 22.0. 

Gtt. xxx — lx ter die ex vino. 
Scorbut. 
143a. 
^ Tr. Ferri chlor. 3 iij. 
Spir. nitrico-seth. 3 vj. 
Tr. Cantharidum 3 ss. 
Aq. fontanae ad § viij. 
P. sexta bis die. Gleet. 

Spermatorrhoea, 



143b. 
^ Tr. Ferri chlorati 3 j. 
Aq. Cinnamomi § vj. 
| j ter die. Haemoptysis. 

143c. 
^ Tr. Ferri Chloridi 3 j. 
Ferri Sulphatis gr. x. 
Aq. Fontis § j. 
Followed by Pot. Carb. 3j, 
dissolved in water. 

Cyan Poisoning. 
144. 
# Liq. Ferri Nitrat. 3 j. 
vel " " Subsulphatis 

Syrupi simplicis § j. 
Aq. destillatae | v. 
| ss ter die. Diarrhoea, 
(with Ancemia.) 



Erigeron Extr. fl.: ; 

Ferrum acet. Tr. gtt. 

" chlor. Liq.: gtt. 

" " Tr.: gtt. 

" nitr. Liq.: gtt. 

" subsulf.Liq.:gtt. 



^ss — 3j= 2.0 
20— 3j= 0.7 

2—10 =0.13 
10—60 = 0.35 

2—12 = 0.13 



—4.0. 
—4.0. 

—0.65. 
—2.0. 

—0.8. 



1 — 8 = 0.065—0.5. 



Erigeron Canadense is mostly used in nephritic dis- 
eases, Gravel and Hemorrhages. Oleum Erigerontis , gtt. 
5 — 20 bihorio in Metrorrhagia. 

Ferrum — Though the preparations of iron are more 
or less astringent, they are chiefly used as tonics. See 
section v. As astringent, Tr. Ferri Chloridi (Tr. Ferri 
chlorati) — Liq. Ferri Chlor. partes 35 et Alcohol, partes 
65 — is generally preferred, which has moreover some 
specific action on the urino-geuital apparatus. Liq. Ferri 
nitr. may be replaced by Liq. Ferri chlor. (pond. spec. 
1.48) et Aq. p. 2. Liq. Ferri subsulf. (Monsel's Solu- 
tion): Gtt. 1 — 3 ex aqua in Hsematemesis. 



ASTRINGENTS. 



67 



145. 

IJ Tr. Kino 3 ss — 3]. 

Mixt. Cret. comp. § ij. 
3 j tertiis horis. Diarrhoea 
Ablactatorum. 
146. 
IJ Olei Macidis 2.0. 

Spiritus aetherei 25.0. 
Gtt. xij bihorio. Colic, 

(hepatic.} 
147. 
IJ Plumbi Acetatis gr. j. 

Opii gr. \. 
Dentur tales doses 6. 
j ter die. Dysentery. 

Vel: 

IJ Plumbi acetici gr. ij — iij. 
Opii gr. ss. 

Placenta Prcevia. 

148. 

IJ Extr. Ratanhae 5.0. 

Aq. Cinnamomi 150.0. 

Mixt. sulf. acid. 1.5. 

Syr. Aurant. C. 25.0. 

1 6 c. c. omni hora vel biborio. 

Metrorrhagia. 



Vel: 

IJ Extr. Ratanhae 

Glycerini 1 10.0. 

Glycerolati simpl. 80.0. 
3 j omni hora vel bihorio. 

149. 
IJ Extr.Rhud.arom.fi. 3 ss. 
Tr. Strychni gtt. x. 
" Ferri chlorati 3 j. 
Elix. simplicis 3 iij. 
Gtt. xx ter die post cibum. 
Incontinence of Urine. 
150a. 
IJ 01. Terebinthinae 5.0. 
.Etheris 20.0. 

Gtt. xv — xxx ex aqua sacch. 
mane nocteque. 

Hepatic Colic. 
150b. 
IJ 01. Terebinthinae 

Sodii Bicarbonat. ? 3 j. 
Mucil. Acacias 3 j. 
Mixt. Amygdalar. 3 vij. 
Pars sexta quartis horis. 

Hematuria. 



Kino Tr.: 3 ss— 3 ij = 2.0 — 8.0. 

PlumbiAcetas.gr. 1—3 =0.065 — 0.2. 
Ratanh. Tr. : 3 j— 3 ij = 4.0 — 8.0. 

Terebinth. 01. gtt. 10— § ss = 0.65 —16.0. 



Kino and Hatanha (Krameria) are similar to Catechu 
(p. 63,) and much used in Pediatrics. 

Plumbum: A prolonged use of the preparations of lead 
in chronic diseases is more or less dangerous, from their 
liability of poisoning the system, known generally by 



68 



ASTRINGENTS. 



150c. 


151b. 


fy 01. Terebinth. 30.0. 


5 Dec. Uvae Ursi 200.0. 


Vitell. Ovorum No. 2. 


Tr. Catechu 


Aq. Menth. pip. 250.0. 


Syr. Zingiberis T 15.0. 


Syr. simplicis 50.0. 


32 c. c. bihorio. 


16 c. c. every \ hour; after- 


Gonorrhoea secundaria. 


wards every hour. 


Vel: 


Phosphor Poisoning. 


£} Extr. Uvse Ursi fl. 3 ij. 


151a. 


Tr. Kino 


r£ Extr. Uvse Ursi 10.0. 


Syr. Zingiberis ^ § ss. 


Sacchari albi 50.0. 


Aq. fontanae § iij. 


Divide in 30 partes sequales 


§ j quartis horis. 


Pulv. *\ quater die. Gravel. 


Incontinence of Urine. 


UvaUrsi, Extr. fl.: 


3ss— 3 j = 2.0—4.0. 



the characteristic discoloration of the gums, etc. The 
most common form of lead poisoning is that known as 
painter's colic. Some forms are characterized by par- 
alysis or painful cramps. 

Oleum Terebinthince is best given with some mucilage. 
Pulvis Saponis makes a good emulsion with it in the 
proportion of 0.66: 30.0, or 1:50. Hyposulfite of Soda 
deodorizes it. See Sulfites, section i. 

In Typhoid, where the abdomen is tympanitic, the 
tongue dry and the bowels ulcerated, gtt. 5 — 20 of the 
oil on sugar every hour or two; 3 j tertiis horis in Hema- 
turia; the same dose every other day in Neuralgia. 

Uva Ursi (Arctostaphylum) has a particular control 
over discharges from mucous surfaces; hence its use in 
Catarrh of the Bladder, chronic Bronchitis with profuse 
discharge, etc., etc. 



SECTION V. 



RESTORATIVES. 

They ultimately restore general health, by either 
gradually, but permanently, invigorating nerve-force: 
Tonics; or by rapidly, though but temporarily, rousing 
the vital functions of the organism: Stimulants. 

Acida Mineral: Tonic, Astringent. 

Albumen: Nutrient. 

Alcohol: Stimulant. 

Ammonium: Stimulant, Antacid. 

Argentum : Tonic. 

Arnica : Stimulant. 

Bebeeria: Tonic, Antiperiodic. 

Berberis: Tonic, Antiperiodic, Cathartic. 

Caffein: Stimulant, Antiseptic. 

Cantharis: Stimulant, Tonic, Diuretic. 

Capsicum: Stimulant. 

Chininum: Tonic, Stimulant, Antiperiodic. 

Coca: Tonic, Stimulant. 

Cuprum: Tonic, Astringent. 

Digitalis: Tonic, Diuretic. 

Ergota: Stimulant, Astringent. 

Ferrum: Tonic, Astringent. 

Gentiana: Tonic. 

Glycerina: Tonic, Nutritive, Laxative. 

Guar ana: Tonic, Astringent. 

Heloni as : Stimul ant. 



10 RESTORA TIVES. 

Hydrastis: Tonic, Alterative, Antiperiodic, Chola- 

gogue, Deobstruant. 
Ipecacuanha: Tonic, Emetic. 
Mangamm: Stimulant, Antiseptic. 
Nux Vomica: Stimulant, Tonic. 
Pancre atinum : Digestive. 
Paraguayensis, Ilex: Tonic. 
Pepsina: Digestive. 
Pepton : Digestive. 
Phosphorus: Stimulant, Tonic. 
Rheum: Tonic, Astringent, Cholagogue. 
Sabika: Uterine Stimulant. 
Zincum: Tonic, Stimulant. 



Stimulants and Tonics. 



71 



152a. 
IJ, Acid, hydrochlor. d. 
Tr. Zingiberis a 3 ij. 
gi Nuc. Vomicar. 3 j. 
Syr. C. Aurantior. § j. 
Aq. destillatae ad § viij. 
§ j ter die post cibura. 

Dilatation 
of Stomach. 
152b. 
IJ Acid, hydrochlor. dil. 
gtt. xl. 
Tr. Nuc. Vom. gtt. xx. 
Aq. Cinnamomi | j. 
3 j ter die. (4 years.) 

153. 
IJ, Acid, nitro-mur. dil. 
Tr. Zingiberis 7 3 ij. 
Tr. Nuc. Vomicae 3 j. 
Aq. fontanae ad § viij. 
§ j ter die post cibum. 

Dyspepsia. 



154a. 
IJ, Acid, phosph. d. 3 iij. 
Tr. Ferri chlor. 3 jss. 
Syr. simplicis f j. 
Aq. Menthae ad. 3 viij. 
I ss ter die post cibum. 

Same, if Anwmia. 
154b. 
IJ Acid, phosph. dil. 3 ss. 
Tr. Nucum Vomic. 3 ij. 
Syr. simplicis § j. 
Aq. fontanae ad 3 viij. 
I ss ter die. Hectic. 

155a. 
IJ Acid, sulfurici diluti 
Tr. Card. comp. ^ 3 ij. 
" Nucis Vomicae 3 j. 
(Tr. Cinchon. co.) 3 ss. 
Syr. simplicis 3 j. 
Aq. destillatae ad 3 viij. 
1 j ter die post cibum. 

Dyspepsia. 



Acid, hydrochlor. d.: 
" nitro-mur. d.: 
" phosphor, d.: 
" sulfuricum d.: 



gtt. 5—30 = 0.35—2.15. 
gtt. 2—20 = 0.15—1.5. 
gtt. 10—60 = 0.65—4.0. 
gtt. 10—30 = 0.65—2.3. 



Mineral Acids are usually classed with tonics, and 
though they exert a considerable corroborant influence 
on the system, their action is in many respects peculiar. 
See sections in. and iv. Acidum nitro-muriaticum 
should not be given with mercurials. 

Acidum phosphoricum is very valuable in Softening 
of the Brain. In Hysteria, Defective Menstruation and 
Spermatorrhoea, 5.0 — 15.0 per diem. 

Acidum hydrocliloratum dilutum, 1:3 Aqua; 

Acidum nitricum dilutum 9 1:4 J. 



72 RESTORATIVES. 

155b. 155c. 

$ Acid, sulfurici d. 3 j. IJ Acid. sulf. dil. 3 jss. 

Tr. Cardam. comp. Spir. setherei | ss. 

" Gent. comp. ^ § j. Glycerinse | j. 

Infusi Colombo § jv. Aq. fontanae ad § viij. 

| ss ter die. Chlorosis. § j quater die. Restorative. 

Induration of Cervix. {after illness.) 

Acid, nitrohydrochlor. dilutmn, 3 et 4:25. The mixed 
acids are left in a bottle for 24 hours, sometimes shaken, 
and then the 25 parts of water added. 

Acidum sulfuricum dilutum, 1 :5 Aqua. (p. 61.) 
Alcohol is the best stimulant to rouse and support the 
system in asthenic diseases, exhausting hemorrhages 
and suppuration; and after the use of the wet sheet, 
etc., if there be a sensation of chilliness. In Typhoid, 
etc., it probably acts as a physiological antidote to the 
blood poison, and should be given in the very first stages 
of the fever. Brandy, § ss — § j hourly (Vinum, § j 
every 6 — 8 hours) if much prostration, pulse being 
above 120; or if the systole becomes less intense and 
resembles more the secSnd sound, as it will produce 
more force and less frequency of the pulse, even reduce 
temperature and diminish delirium. (If excitement is 
produced, it is not indicated, or the doses are too large.) 
In Diphtheria, with or without Quinine, as much as can 
be borne without producing Alcoholism, is said to be 
curative. In Dysentery, if great prostration (40 oz. in 
24 hours have produced no excitement.) In functional 
disorders of the stomach it is generally beneficial; but 
in Gastritis, brandy frequently produces distress. In 
Diarrhoea, if much prostration, to child of 5 — 8 months 
gtt. v in 3 j of milk every 2 hours; the same in collapse 
of Cholera Infantum. In Sporadic Cholera, \ oz. with 
water at short intervals, if much prostration and it be 
borne; in Asiatic, with water for thirst, and \ oz. with 
2 oz. of tea as enema every half hour or hour during 
collapse; in Pneumonia, if pulse frequent, thrilling, but 



Stimulants and Tonics. 



IS 



156. 
5 Album. Ovorum No. 4. 

Aq. fontanae 1000.0. 

Cyathus viuosus every 5 — 
10 minutes. 

Sublimate Poisoning. 
157a. 
IJ, Spir. Ammon. arom. 
" setherei 7 3 j. 
" Vini Gallici 3 ij. 
3 ss — 3 jprodosi. Syncope. 

157b. 
]J Spir. Ammon. arom. 3 ]- 
Tr. Card. comp. § ij. 
Syr. Zingiberis | j. 
3 ij semis horis ex aqua. 

Cholera. 



158a. 
Ij, Ammon. Carb. 3j. 
Spir. aetherei 3 j. 
Aq. Menth. pip. § vj. 
P.quartasubinde. Syncope. 

158b. 
5 Ammon. carb. gr. xxv. 
Tr. Card. comp. 3 ij. 
Aq. Fontis | iij. 
Pars semis cum Acid. citr. 
gr. xv. Insolation. 

158c. 
5 Ammon. carbon. 3 j. 
Tr. Cardam. comp. 
" Cinchon. ^ 3 ij. 
Aq. fontanaa ad § vj. 
| ss ter die. Embolism. 



Ammon. arom. Sp. gtt. 
Ammon. Carbon.: gr. 



20— 3 j = 1.0—4.0. 
3—10 = 0.2—0.65. 



compressible. (To child of 14 months 1 oz. was given 
hourly, besides Ammon. carb. and Morph. and the pulse 
fell from 200 to 120, and respiration from 120 to 50 per 
minute.) In Yellow Fever, per os et per amim, to 
sustain the strength; in Cerebro-spinal Meningitis; in 
Angina Pectoris; in Insolation or Passive Hyperemia 
or Embolic Apoplexy, etc. In Tetanus it may be given 
until intoxication. 

Ammonii Carbonas (p. 43) is especially valuable in 
Pneumonia; but it is also employed in expediting the 
eruption of exanthematous fevers, either as Carbonate 
pure in powder or watery solution; or converted into 
the Acetate. With Camphora (No. 55) it is sometimes 
of especial value in Cholera; and combined with Aci- 
dum salicylicum, both its internal and external use has 
been recommended to counteract the effects of snake 
poison. 



74 



RESTORATIVES: 



158d. 
r> Ammon. Carb. 3j. 

Extr. Chelidonii fl. 
vel " Stilling, fl. 3 iij. 

Aq. Menthse ad § vj. 
| ss ter die. Icterus, 

159a. 
5- Ammon. Carbon. 3jv. 

Ferri Tartratis 3 ss. 

Syr. Zingiberis § j. 

Inf. Colombo § vij. 
§ ss ter die. Hysteria. 

159b. 
3 Ammon. carbonici 

Ferri ammoniati ^ 3j. 

Syr. Zingiberis § j. 

Inf. Colombo § v. 
| j ter die. Alcoholism. 



160a. 
t> Argenti nitrici cryst. 

Micae Panis 

Acacise ~ gr. x. 
F. pilulae 12. Paralysis. 
j ter die. (bulbar.) 

(for several weeks. ) 
160b. 
r> Argent, oxydat. gr. vj. 

Extr. Hyosc. gr. xxjv. 
F. pilula3 12. 

j bis vel ter die. Epilepsy. 
161. 

Bebeeriae sulfuric. 2.0. 

Acid. sulf. dil. gtt. xxv. 

Syr. C. Aurantior. 30.0. 

Aq. destillatse 160.0. 

c. c. ter die. Tonic. 



5 



16 



Argent. Nitras: gr. J — 1 
Argent. Oxid.: gr. \ — 2 
Arnica Tr.: gtt. 15 — 3 j 
Bebeer. Sulfas. : gr. 5 — 3 j 



0.015—0.065. 
0.015—0.13. 
0.5 —4.0. 
0.32 —4.0. 



Argenti Nitras (Argentum nitricum) is one of the 
most valuable remedies in Epilepsy. It is also used in 
Locomotor Ataxia and Chorea. If used for some time 
it has the effect of discoloring the skin, which is not 
the case with the oxide. In. Chorea and Neuralgia: 
Arg. iodatum 0.004 — 0.01 ter die, vel Arg. cyanatum 
0.002—0.006 ter die. 

Argent, tod. 0.1 = Arg. nitr. et Kal. iodatum 7 0.07. 

Arnica is occasionally of value in Amaurosis, Paraly- 
sis and other nervous affections. Tr. gtt. xx — xxx in 
nervous headache with Tinnitus aurium. 

Bebeerinum (from Nectandra Rodiaei) and Berberina 
(from Berberis vulgaris and Hydrastis Canadensis) are 
said to be tonics of first order (page 24.) 



Stimulants aud Tonics. 



75 



162 e 
r> Extr. Berberis fl. § j. 
Extr. CocaB fl. 3 ss. 
M Cypripedii fl. 
M Valerianae fl. IT 3 ij. 
Elix. simplicis 3 ij. 
3 j ter die ante cibum. 

Uterine Tonic. 

163. 

5 Coffeini citrici 1.0. 

Alcoholis diluti 16.0. 

Chloroformii 12.5. 

Gtt. xv — xx semis horis. 

Migraine. 
164a. 
5 Tr. Cantharidum 
" Capsici 
" Colombo ? 3 j. 
Mucilag. Acaciae ad 3 ij. 
3 j ter die. Menorrhagia. 



164b. 
5- Tr. Cantharidum 
" Cinchon. comp. 
" Ferri chlorati 
" MyrrhsB ^ 3 ij. 
Gtt. xx ter die. 

Spermatorrhoea. 
165. 
]J Capsici pulv. 3 ij. 
Sacchari albi 3 j. 
Divide in p. 4. Delirium 
j omni hora. tremens. 

166a. 
5 Chinin. sulfur, gr. xv a 
Acid. sulf. diluti 3j. 
Tr. Cardam. comp. 
" Humuli JT 3 iij. 
Inf. Rosarum ad § vj. 
I ss bis vel ter die. 

Chlo?*osis. 



Berber, aquif. Extr. fl.: gtt. 20— 3 j = 1.0 —4.0. 
Caffeina: gr. 1— 2 = 0.065—0.13. 

Cantharis Tr.: gtt. 4—15 = 0.13 —0.5. 

Capsicum: gr. 2 — 10 =0.13 — 0.65. 

" Tr.: gtt. 10— 3 j =0.32 —4.0. 

Caffeina (Coffeinum) in headache may be given 
0.03 — 0.05 every half hour or hour; 0.05 — 02. every 
2 — 4 hours. 

Cantharis (Cantharides) must be used with caution. 
See page 47. 

Capsicum is often used as an adjunct, to rouse the 
susceptibility of the stomach, chiefly in the Dyspepsia 
of drunkards: Tr. 3 j — 3 ij. 

Quinince Sulphas (Chininum sulfuricum) is very 
much used as stomachic or general tonic; only where 
gastric susceptibility exists, as in convalescence from 
acute diseases, some of the simple bitters are preferable. 



76 



RESTORATIVES: 



166b. 
IJ Quininae Sulphatis 

Acid. sulf. dil. ? 3j. 

Syr. Zingiberis § jv. 
3 j ter die. Anosmia. 

166c. 
5 Chinim sulfurici 3 ss. 

Pulveris Rhei 3 j. 
Divide in partes 30. Same. 
j ter die. {with Anasarca.) 
Vel: 
I£ Chinini sulfurici 3 ss. 

Extr. Gentianae 3ij. 

Pilul. Rhei comp. 3jv. 
F. pilulae 30. j ter die. 
Vel: 
rj Chinini sulfurici 3ij. 

Rad. Zingiberis ±>j. 
F. pilulae 20. Menorrhagia. 
j ter die. Mania. 

167a. 
5- Chinin. sulf. 3ij. 

Ferri sulfurici 3j. 

Acid. sulf. arom. gtt. x. 
Divide in 20 partes aequales 
in capsul. gelatinos. 
j ter die ante cibum. 

Pelvic Abscess. 



167b. 
rj Quininae Sulphatis 3j. 
Tr. Ferri Chloridi 3 ss. 
Syr. C. Aurant. § j. 
Aq. destillatae § vij 
3 j bis vel ter die. 

Pulmon. Gangrene. 
Vel: 
t> Tr. Cinchonas 

" Gentianae 'a -| j 
Liq. Potassae 3 ij. 
Aq. Menthae § vj. 
§ j bis vel ter die. Same. 

167c. 
5 Tr. Cinchon. comp. 
" Colombo 
" Gentianae 
" Quassiae ^ | j. 
Morph. sulf. gr. j — ij. 
3 j ter vel quater die. 

Delirium tremens. 
168a. 
t> Cocain. hydrochl. gr. j. 
Alcoholis q. s. 
Aq. destillatae f ss. 
3 j every \ hour if neces- 
sary. Vomiting 
of Pregnancy. 



Cinchon. Tr.: 3 j — 3 iij = 4.0—12.0. 

In Anasarca, etc., it is supposed to restore the lost 
albumen to the blood. See page 11. As tonic to child 
of 4 years may be given gr. \ bis die; in Dropsy from 
Dysentery, gr. \ ter die. (3 years.) 

Cocaine. Aside from being a most valuable local 
anaesthetic, it is one of the best remedies in affections 
of a nervous nature, General Debility, Hysteria, Spinal 
Irritation; it is also used in Anaemia and Consumption, 



Stimulants and Tonics. 77 

168b. 170. 

£> Cocaini hydrochlor. r>, Cupri ammoniati 1.5. 

gr. iij. Aq. destillatse 25.0. 

Alcoholis diluti Gtt. v bis die. Chorea. 

Glycerinae Vel: 

Aq. destillato 7 3 ij- g Cupri ammoniati 3j. 

3 ss — 3 j ter vel quater die. Micae Panis q. s. 

Angina Pectoris. F. pilulae 40. 

169. j hora som^i. Epilepsy. 

g Tr. Cupri acet. R. 3j. 171a. 

Aq. destillatae | jv. IJ Inf- Digital. ( 3 j) | vij. 

3 j ter die post cibum. Syr. Cinnamomi § j. 

Albuminuria. § j hora somni. Epilepsy. 



Cupr. ammoniat. : gr. \ — 1 = 0.015 — 0.065. 
Digital. Extr. fl.: gtt. 5—40 = 0.18 —1.3. 

In Angina Pectoris it does not shorten the paroxysms, 
but it relieves them, and after a few days use they 
disappear altogether. It is also a reliable aphrodisiac, 
and in Alcoholism it is said to be the remedy par ex- 
cellence, as it will even produce disgust of the drinking 
habit. Unfortunately, if not given with care, it may 
produce Cocainism, which is to Morphinism what a full 
grown oak is to a sapling. See pp. 109, 112 and 115. 
As cardiac stimulant it is usually given in doses of 
grain \ — 1 bis vel ter die. In Seasickness, Cocaine 1 per 
cent, solution gtt.v ter die on apiece of ice. Extractum 
Cociefl. 3 ij — 1 ss in timidity (for public speakers.) 

Extractum Cocce fluidum 3 j = gr. 1^ of Cocaine (?). 

Cupri Sulphas (Cuprum sulfuricum) is mostly used 
as astringent; as tonic, in doses of gr. \ — 1 in pill, 
repeated, so as not to occasion vomiting, it is a good 
remedy in obstinate Intermittens, Neuralgia and essen- 
tial nervous diseases, (p. 65.) Tr. Cupri acetici Rade- 
macheri is very efficacious in Bright's Disease. (After 
3 weeks use the albumen in the urine is usually much 
diminished, and scarcely any blood left.) Cuprum 



IS RESTORATIVES: 

mt>. 172a. 

5 Tr. Digitalis $ Ergotinae 

Spir. aetherei ? 5.0. Ferri sulfurici 

Tr. Colombo 10.0. Aloes ^ gr. x. 

4 c. c. bis die. Palpitation. F. pilulae 10. 

lYlc. j mane nocteque. 

3 Tr. Digitalis 3j. Vel: 

Spir. nitrico aeth. | ss. 1J, Tr. Ergotae 3 ij. 

Tr. Cardam. comp. § j, Syr. Croci § ij. 

Aq. fontanae ad § vj. Dec. Aloes comp. § vj. 

§ j bis die. Valv. Lesions. 3 ss ter die. Amenorrhea. 



Digitalis Tr. : gtfc. 10—80 = 0.32—2.6. 

ammoniatum 0.1 — 0.15 per diem in Neuralgia Nervi 
Quinti is said to be almost specific. 

Digitalis is very useful in most heart diseases — Dilata- 
tion, fatty degeneration, failure or irritability of heart's 
action, and valvular lesions, etc., provided the action be 
feeble, as it increases the force of the cardiac contrac- 
tion and diminishes the irregular movement — in incom- 
plicated Hypertrophy it is, of course, objectionable. On 
account of its diuretic property it is frequently employed 
in dropsical effusions, especially in conjunction with Colchi- 
cum (p. 50) or Potassium (p. 96); even as embrocation it is 
of value (p.144.) (As cardiac tonic, Strophanthus is said to 
be superior to Digitalis, as, aside from not causing the 
slightest disturbance to digestion,it is neither depressing 
nor cumulative in its effects.) Inf. Digitalis (No. 1*71) in 
Epilepsy should be given in 1 oz. doses only for one 
week; in the second week it may be increased to 1-J- oz. 
and the third to 2 oz., until sickness of stomach and 
dilatation of pupil, when the dose has to be reduced. 
In Insomnia and forgetfulness of old people: Extractum 
fluidum gtt. v tertiis horis; in Delirium tremens: Tr, 
3 j in 2 doses after an interval of 4 hours. 

Ergot (p. 65) is a special stimulant to the spinal 
marrow and the uterus, hence the remedy par excellence 






Stimulants and Tonics. 79 

172b. 173b. 

t> Extr. Ergotae i> Ferri carbon, gr. xxjv. 

Camphor* IT gr. x. Radicis Rhei 

F. pilule 10. " Zingiberis 

j bis die. Spermatorrhoea. Extr. Gentian IT gr. xij. 

172c. F. pilulse 12. 

r> Extr. Ergotae fl. 4.0. j ter die. Meteorism. 

" Viburni fl. 6.0. 174a. 

Gtt. xv ter vel quater die. 5 Liq. Ferri sesquichlorati 
Dysmenorrhea. Syr. simplicis ^ 10.B. 

173a. . Mixtis adde 

r> Tr. Ferri acetici 3 j. Liq. Ammoni caust. 

Syr. Zingiberis 3 j. Spir. Menthae p. ? 5.0. 

Aq. Pimenti ad § vj. Gtt. xx — xl ter die ex aqua. 
I j ter die. Exhaustion. Steel drops. 

Ferr. acet. Tr.: gtt. 20— 3 j = 0.7 —4.0. 
" carbon.: gr. 5 — 15 = 0.32 — 1.0. 
" chlor.Liq.:gtt. 2 — 10=0.13—0.65. 
" " Tr.: gtt. 10— 60 =0.35—2.0. 

in all cases of uterine inaction, unless the coexistence of 
certain circumstances prohibits its use. Combined with 
iron it is very often of benefit in Incontinence of Urine. 
The addition of Strychnine gr. 1-20 (No. 172a) is some- 
times particularly useful. {Ergotina is another name of 
the Extract of Ergot, which has a share in the existing 
confusion of the present nomenclature — see my re- 
marks on this subject in Preface.) 

Ferrum introduced into the stomach is changed into 
a sulfuret, and it is only during this process that its 
absorption takes place. Ferri Chloridum (Ferrum 
chloratum) is the most effective iron salt, a non-poison- 
ous antiseptic, antizymotic and haemostatic, and milder 
than Ferri Sulphas, (p. 66.) The liquor taken with 
Glycerin or with milk will lose the styptic taste, nor 
will the teeth suffer. No. 174b contains 3 per cent. 
Ferrum, and if the chloride be of 1.26 spec, gravity, the 
proportion to Glycerin would be = 33:67. Ferri Car- 



80 BESTOBATIVES: 

174b. 175b. 

r> Liq. Ferri chlor. 20.0. I> Ferri Sulphatis 

(pond, specif. 1.48.) Sodii Bicarbonatis 

Glycerinae 80.0. Extr. Gentianae ^ 5.0. 

3 j — 3 iij ter die e lacte. F. pilulae 75. iij — jv daily. 

174c. Vel: 

1J Liq. Ferri Chloridi 2.5. IJ, Ferri sulfurici 5.0. 

Glycerini 97.5. Extr. Myrrhae 

4 c. c. every -J- hour. Croup. Galbani ^ 15.0. 

175a. F. pilulae 150. 

IJ Ferri sulfurici 3j. v quater die. Chlorosis. 

Extr. Gentianae J)ij. Vel: 

F. pilulae 40. r> Sol.Ferri etPot.Tartrat. 

ij bis die. Urethral (20.0—30.0) 200.0. 

(j: 7 years.) Inversion. 3 ij as drink. 



Ferr. dialysatum: gtt. 10—40 = 0.65 — 2.6. 

" oxyd. hydr.: gr. 5 — 20 = 0.32 — 1.3. 

" sulfuricum: gr. 1 — 3 = 0.065 — 0.2. 

Ferro-Kali tartar.: gr. 2— 8 = 0.13 — 0.5. 

bonas (Ferrum carbonicum) gr. iij bis die to improve 
digestion. In Chorea from fright. (6 — 10 years.) Ferrum 
dialysatum gtt. ij — v bis vel ter die in Heartburn. It 
is almost tasteless, and with water perfectly miscible. 
Ferri Oxidum hydratum (Ferrum oxy datum) is easily 
dissolved in the stomach, therefore small doses of it 
have the same effect as big ones of the other oxides. 
Fresh prepared, it is of special value in poisoning with 
Arsenic, for which reason a bottle with Liq. Ferri ter- 
sulf. should be always at hand. An expeditious pre- 
paration of the hydrated oxide of iron in cases of arseni- 
cal poisoning may be performed in the following 
manner: To Liq. Ammon. U. S. P. 240.0, previously 
diluted by double its quantity of water, add Liq. Ferri 
tersulf. 300.0, previously diluted by 3 liters of water, 
constantly stirring. Pour the whole on a muslin strainer, 
and after having pressed with the hand the water all out 



Stimulants and Tonics. 81 

176a. 177. 

5- Ferri Vin. amar. § iijss. 5 Inf. Gentian, comp. 

Tr. Nuc. Vomic. § ss. vel Inf. Colombo § vj. 

Sol. Potass, arsen. 3 ij. Liquor. Potassae 3 iij. 

3 j ter die post cibum ex 3 ss ter die. Induration 

aqua. Same. of Cervix. 

176b. 178. 

IJ, Ferri Yin. dulc. I> Extr. Guaranse fluidi 

Tr. Colombo a 3 jv. Elix. Valer. ammon. 

Kalii bromati 3 v. Glycerini 'a | j. 

3 ij ter die ex aqua. 3 j — 3 ijterdie. Heartburn. 

Pelvic Peritonitis. Cephalalgia. 

Ferri Vinum: 3 j — 3 jv = 4.0 — 16.0. 

Gentiana Extr. fl.: gtt. 20— 3 j = 1.0— 4.0. 

" Tr. 3 j — 3 ij = 4.0— 8.0. 

Glycerinum: 3 ss— | j = 2.0 — 32.0. 

Guarana Extr. fl.: gtt. 20 — 3 j = 1.0 — 4.0. 

of the precipitate, add enough water to make the whole 
600.0 (about 20 oz.) 

Gentiana lutea possesses in a high degree the tonic 
powers which characterize the simple bitters; therefore 
its value in cases of debility of the digestive organs, or 
where a general tonic is required. 

Glycerinum (Glycerina) is, like alcohol, an indifferent 
and very hygroscopic substance; and Glycerinismus, 
chronic or acute, is said to be likewise similar to Alco- 
holism. It is used in Phthisis as nutritive instead of cod 
liveroil; in Diabetes mellitus, 150.0 — 200.0 daily, instead 
of sugar; and sometimes in Dyspepsia (3.0 — 5.0 after 
meals), especially if feces hard and dry. Barring a few 
chemicals, which like Argenti Nitras, Potassii Perman- 
ganas and Acidum chromicum, are decomposed by it, 
Glycerina is, on account of its great solvent power, one 
of the most important menstrua we possess — 100 parts, for 
instance, will readily dissolve 10 p. of Acid, benzoicum, 
the same quantity of Acidum boricum, 40 p. of Alum, 50 
p. of Tannin and 60 p. of Borax. 



82 BE STOMA TIVES: 

179. 181. 

r> Extr. Helon. fl. § j. r> Vin. Ipecacuanh. 3 ss. 

Glycerinse % ij. Gtt. iij omni hora. 
| ss ter die. Hysteria. Vomiting of Pregnancy. 
Uterine Tonic. 182. 

180a. 5- P°t- Permang. gr. ij — v. 
IJ Hydrastin. gr. vj. Aq. destillatse § ss. 

Extr. Capsici gr. j. This dose ter die. 
F. pilulae 6. Insomnia. Amenorrhea. 

j ter die. Irritable Stomach. 183. 

180b. ^ Extr. Strychni gr. x. 
§, Hydrastin. 3 ss. " Hyoscyami 

Extr. Nuc. Vom. gr. jv. Chinin. sulfurici T 3j. 

F.pilulsel6.Consp.Cinnam. F. pilulge 20. 

j ante cibum. JDyspepsia. j ante prandium. JPhthisis. 

Helonias Extr. fl. : 3 ss — 3 j =2.0 — 4.0. 
Hydrastis " fl.: gtt. 20 — 3 jv = 1.0 — 16.0. 
Ipecacuanh. Vin.: gtt. 3 — 3j =0.1 — 4.0. 
Mang.Pot.Per.: gr. f— 5 =0.032— 0.32. 
Nux Vom. Extr.: gr. -J— 1 =0.008— 0.065. 
" " Tr.: gtt. 5—20 =0.16 — 0.65. 

Ipecacuanha is chiefly used as emetic. See section 
vn. As tonic and stomachic, gr. 1-10 subinde; in Dys- 
entery, one 3 ss dose in capsul. amyl. v. galatin. every 
night, after having prepared an hour before its adminis- 
tration the stomach by Opium (gr. j) p. os, or by Mor- 
phinum hypodermically. (p. 110.) In Convulsions from 
eruptive fevers, gr. -J- — J every 10 minutes. (3 years.) 

Permanganas Potassii (Potassae Permanganas — Kali 
hypermanganicum) though excellent in Dysmenorrhea 
from torpor, is contra-indicated in the congestive and 
obstructive forms. In defective Menstruation its use 
should be commenced a few days previous to the men- 
strual period. Sometimes it is employed in Impotence 
from Anaemia and depression. In the administration of 
it, glycerin or alcoholic menstrua must be avoided, as it 
is decomposed by them. 



Stimulants and Tonics. 83 

184a. 184b. 

IJ, Strychnine Nitratis 0.1. IJ Strychn. nitrici gr. ij. 

Glycerini 10.0. Conf. Rosarum q. s. 

Gtt. jv— xij (0.002— 0.00G) F. pilulse 24. 

bis vel ter die. Paralysis, j bis die. Paraplegia. 

Vel: 184c. 

IJ Strychnini gr. j. IJ Tr. Strychnini 5.0. 

Acidi acetici gtt. ij. Aq. Laurocerasi 10.0. 

Elix. simplicis | ij. Gtt. x mane nocteque. 

3 j mane nocteque. Vomiting of Pregnancy. 



Strychnina gr. 1-60—4 = 0.001—0.008, 



Nux Vomica (Strychnos) is the remedy par excellence 
in torpid or paralytic conditions of the motor and sensi- 
tive nerves, or of the muscular fibre, if not dependent on 
structural lesions; hence its value in lead palsy and 
paralysis from drunkenness. It is no less useful in Par- 
alysis, the consequence of cerebral hemorrhage, which 
continues often for an indefinite time after the absorp- 
tion of the effused blood, as in Amaurosis without cere- 
bral complications. As general tonic, whenever there is 
a loss of nerve power, Impotence, Spermatorrhoea, In- 
continence of Urine, etc., it seldom fails to give satisfac- 
tion. It has, however, to be used with caution, though 
a tolerance for it is soon established in the system. In 
Vomiting of Pregnancy, Tr. Nucis Vomicae gtt. ij — iij 
bihorio; in Gastralgia or Chronic Vomiting, Extr. 
Strychni gr. ^, vel Strychninum gr. 1-10 ter die; in 
Chorea, gr. 1-25. Action and dose of the various salts 
of Strychnina are about the same. (0.01 is the strong- 
est dose, and 0.03 per diem — 0.05 may kill.) The best 
Antidote is Chloral 2.0 — 4.0 or Morphium (1:2 parts 
Strychn.) in Aq. Amygdalar. amarar. cone. (See page 6.) 
Tr. Strychnini — Strychnin, 0.1. 

Alcohol, dil. 20.0. (1.0=0.005.) 



84 



RESTORATIVES: 



185. 




187b. 


IJ, Pancreatini 




IJ Pepsini 3jv. 


Acaciae ^ 5.0. 


Acid, hydrochl. d 3 j. 


Natri carbonici 




vel " nitrici dil. 


Boracis ^ 1.0. 


vel " phosphorici d. 


Aq. f ontanae 


10.0. 


Tr. Nuc. Vom. a 3 ij. 


Olei Jecoris 


60.0. 


Glycerinae \ ij. 


Aq. Menthae pip. 


20.0. 


Aq. Fontis ad | viij. 


8 c. c. subinde. Debility. 


3 ss ter die post cibum. 


186. 




Dyspepsia. 


IJ, Extr. Paraguayens 


. fl. 


187c. 


Elix. simplicis ^ I 


N- 


IJ, Pepsini gr. xv. 


3 j- 3 ijterdie. Exhaustion. 


Acid, phosph. d. gtt. xv. 


187a 




Tr. Cinnamomi 3 ij. 


IJ, Pepsini 


2.0. 


Syr. simplicis 


Salicini 


1.0. 


Aq. f ontanae ^ % j. 


Glycerinae 


50.0. 


3 j omni bora. 


4 c. c. pro dosi. 




Cholera Infantum. 


Pancreatin: 


gr. 5 


—25 = 0.32—1.6. 


Pepsinum: 


gr. 5- 


—15 = 0.32—1.0. 



Pancreatin is a good digestive, especially of fatty 
matter, and may be given in alcobol or glycerin. 

Ilex Paraguay ensis furnisbes a beverage, wbich in 
some parts of S. America fills tbe place of our tea and 
coffee; but it does not exalt the peripheral nerves like 
the former. It is very efficient in exhaustion from 
hunger and fatigue. 

Pepsine dissolves albuminoid substances and converts 
them into peptones; but it is, without an acid, inert, 
and its best solvent is hydrochlor. acid. Whilst pure 
Pepsine will dissolve 450 times its weight of albumen, 
the saccharated Pepsine, U. S. P., dissolves only 50. It 
is probably more efficient in the treatment of children 
than of adults. Cancer, Erosions and Ulcers of the 
stomach prohibit its exhibition; in these cases Pepton 
would be indicated, as this enters the blood without 
previously undergoing digestion. 



Stimulants and Tonics. 85 

188. 189c. 

3 Pepti pultif. 25.0. R Phosphori gr. j. 

Laclis 1000.0. Strychnini gr. jss. 

As food. Convalesce?is Ferri carbonici 3 ij. 

of Infants. Chin, sulfurici 3 j. 

I89a. F. pil. LOO. Consp. Cinnam. 

5 Phosphori gr. ij. 190. 

01. Terebinthinae 3ij. 5 Tr. Rhei vinos*© 50.0. 

Spin Rosinarini 3j. " Cardam.comp. 10.0. 

iEtheris ad 3 ijss. 16 c. c. ex vino. Stomachic. 

Gtt. vj bihorio. 191. 

Palsy of tongue. IJ Radicis Rhei 3 j. 

]89b. Natri bicarbonici 

5 Elix. Phosphori et Tr. Colombo. 7 3 ij. 

Damian. § ij. Aq. Menthae ad § vj. 

3j ter die. Impotence. 3 ij t.d. Pruritus pudendi 

Phosphorus: gr. 1-60—1-12 = 0.001—0.005. 
Rheum: gr. 5—30 = 0.32 — 2.0. 

" Extr. fl.: gtt. 30—60 =1.0 —2.0. 

Phosphor is much employed in degeneration of nerve 
tissue and in nervous exhaustion, especially in Neuralgia 
and cerebral softening. In overdoses it is a most violent 
blood-poison; if chronic: Ptyalism, inflammation of gums 
and respiratory organs, with bleeding ulcers in the mouth; 
if acute: Gastro-enteritis, faintings, cramps, paralysis, 
etc. As tonic it may be given in doses of from 0.0003 
— 0.0005 ter die; and in Impotence, etc., 0.001 — 0.005; 
but the use of Zinc, phosph. is decidedly preferable. 

As for Damiana (189b) it produces Polyuresis, with 
excitement of the sexual organs, but it may be thor- 
oughly replaced by Bucco or Ferrum. After its use 
for 2 — 3 months the sexual functions are said to be re- 
established, which result is perhaps better obtained with 
small doses of Ferri Chloridum, Quinine and Aromatics. 

Rheum (p. 94) is only in small doses a tonic and also 
a little astringent. (Nos.117 & 166.) As digestive it is 
given in doses of from 0.2 — 0.5. 



86 



RESTORATIVES: 



192a. 

# Olei Sabine 2.5. 

Tr. Colocynthidis 

" Capsici ? 5.0. 

" Arnicae 10.0. 

Gtt. x — xx quater die ex 

aqua sacch. Paralysis. 

192b. 
IjL Summitatum Sabinae 

Cort. Cinchona ^ 15.0. 

F. Infusum "'250.0. 

Syr. Cinnamomi 30.0. 

| ss bihorio. Metrorrhagia. 

193. 
I£ Zinci Oxidi 3 j. 

Extr. Valerianae 3 ss. 
F. pilulae 30. 
j ter die p. cibum. Chorea. 



194a. 
P>, Zinci phosphorici 1.0. 
Acid, phosphor. 7.5. 

Tr. Cinchonae 10.0. 

Gtt. xxv ter die ex aqua. 

Epilepsy. 
194b. 
rj Zinci Phosphidi gr. jv. 

Rd. Althaeae q. s. 
F. pilulae 12. 

j ter die. Sclerosis. 

( Cerebrospinal^) 
194c. 
r> Zinci phosph. gr. j — iij. 

Sacchari albi 3j. 
Divide in partes 10. 
j ter die. Impotence 

Tabes Dorsualis. 



Sabina Oleum: 


gtt. 


1—4 = 0.032—0.13. 


Zincum oxydat: 


gr. 


1—5 = 0.065—0.32. 


" phosph.: 


gr. 


1.16— i = 0.004—0.02. 



Sabina is one of the best uterine stimulants, and much 
used in hemorrhage after abortion. Ol. Sabince, 0.05 — 
0.2 (gtt. 1 — 6) bis vel ter die with brandy in Paralysis. 

Zinc Preparations are similar in their effect to the 
preparations of copper, but milder. 

Zinci Acetas (Zincum aceticum) gr. 4 — 6 per diem in 
mucilage is sometimes used in Delirium tremens. Zinci 
Bromidum is preferable to the Chloride in Tremor 
senilis, Hysteria, Paralysis, Epilepsy: 0.005 — 0.015 ter 
vel quater die ex aqua; 0.02 maximum. Zincum cya- 
natum is best given as powder: 0.005 — 0.015 ter die; 
0.03 maxim. — 0.1 per diem. Zincum oxy datum in gr. iv 
doses ter die, has been found of great service in the 
profuse perspirations of Phthisis. No. 193: Each week 
the quantity may be increased by gr. ij per diem until 



Stimulants and Tonics . 



87 



195a. 
3 Zinci Sulphatis gr. x. 

Extr. Anthemidis 3 ss. 
F.pil. 10. Consp.Lycopodio. 
j ter die. Oxaluria. 

195b. 
^ Zinci sulfurici 

Extr. Hyoscyam. ? 3 ss. 

(Extr. Gentian. 3 j.) 
F. pilulae 30. Nervous 

j ter die. Exhaustion. 



196a. 
rj Zinci valerian, gr. ij — x. 
Extr. Anthemid. gr. iij. 
Ter die. Same. 

196b. 
r> Zinci Valerianatis 0.1. 
Elix. simplicis 50.0. 

Aq. fontanae 100.0. 

16 c. c. every half hour. 

Migraine. 
Hysteria. 



Zincum sulfuric: gr. \- 
" valerian.: gr. \- 



-30 = 0.032—2.0. 
2 = 0.032—0.13. 



gr. xlv are reached. Zinci Phosphidum (Zincum phos- 
phoricum) supplements Phosphorus for internal use, and 
is much easier to employ. Zinci Sulphas (Zincum sul. 
furicum) is often used as emetic in cases of poisoning. 
See section vn. As tonic it is of great value in Oxaluria 
(195), especially if nitromuriatic acid is given at the 
same time. (p. 72.) Gr. j once daily in Chorea from 
fright, which may be increased to gr. vj. daily to child 
of 6 years. 



SECTION VI. 



CATHARTICS 

Remove retained feces, morbid secretions or poison, by- 
producing alvine evacuations, with or without irritation, 
increased peristalsis and effusion of serum from the 
bowels, or of bile from the liver; they relieve spasm or 
congestion and inflammatory action of the general sys- 
tem; promote absorption; stimulate the secretions of the 
liver and purify the blood, invigorating and refreshing 
at the same time the circulatory and nervous powers. 

1. — Laxative: Fruit, Glycerina, Oleum Olivarum, 
Oleum Ricini, Sulfur, etc. 

2. — Laxative and Cholagogue: Mercurial Cathar- 
tics. 

3. — Mildly Hydragogue: Saline Cathartics. 

4. — Mildly Acrid: Rhamnus Frangula, Senna, etc. 

5. — Mildly Acrid and Cholagogue: Rheum, 
Aloes, etc. 

6. — Drastic: Colocynthis, Elaterium, Cambogia, 
Jalapa, Scammonium, Oleum Tiglii, etc. 

7. — Drastic and Cholagogue: Colchicum, Podo- 
phyllum etc. 

(88) 



CATHARTICS. 



89 



197a. 
IJ, Extr. Aloes 
Ferri sulf. ? 3 j. 
(Rad. Rhei 3ss.) 
F. pilulae 30. Chlorosis. 

j vel ij hora somni. 

197b. 
5 Aloes gr. xxjv. 

Acid. sulf. fortiss. gtt.vj. 
F. pilulae 6. 
ij quarta quaque hora. 
Vel: 
5 Aloes 

Rad. Rhei ^ 3 j. 
Sapon. med. 3 ss. 
F. pilulae 30. 
j vel ij subinde. 

Palpitation. 
Prolapsus Uteri. 



197c. 
IJ, Aloes 

Mass. Hydrarg. ^ gr. jv. 
Saponis medicati gr. ij. 
F. pilulae 2. 
Sumatur hora sornni. 

Pruritus pudendi. 
198. 
IJ, Extracti Aloes 4.0. 

Tartar! emetici 0.25. 
F. pilulae 60. 
ij bis vel ter die. Insanity. 

199a. 
5 Extracti Aloes 3j. 
Asae foetidae 2>ij. 
Extr. Nuc. \ omicae 
" Belladorin.^ gr. x. 
F. pilulae 20. 
j anteprandium. Hysteria. 



Aloes, which is also slightly tonic and emmenagogue, 
ranks as purgative between Rheum and Senna, being 
rather slow in its effect. It is chiefly used in Dyspep- 
sia with constipation, dependent on a torpid condition 
of the large intestine or liver, and in Hemorrhoids; as 
revulsive in cerebral affections and in defective men- 
struation; but it is objectionable in diseases of thegen- 
ito-urinary apparatus, pregnancy, etc., on account of its 
special action on the large intestine and the pelvic vis- 
cera generally. The dose is gr. v — x; Tr. § ss — |j; 
Tr. Aloes c. Myrrha 3 j — 3 ij. Ferrum sulfuricum 
increases its action, and prevents, moreover, griping. 
In Constipation from retained feces: Tr. Aloes cum 
Myrrha 3j ter die: in Hysterical Meteorismus: Decoc- 
tum Aloes semel vel bis die; in defective Menstruation: 
Pilulae Aloes cum Myrrha gr. v hora somni (to begin a 
day or two before Menstruation). No. 197b is a very 
powerful aperient. 



90 



CATHABTICS. 



199b. 
IJ Extracti Aloes 
Chinin. sulfurici 
(Ferri sulf.j a 3j. 
Extr. Nuc. Vomicar. 
" Hyoscyam.r gr. x. 
F. pil. 20. j p. prandium. 

200. 
IJ, Dec. Aloes comp. § viij. 
Potass. Bicarb. 3 ss. 
Tr. Aurant. Cort. 3 ij. 
Cyathus vinos, omni mane. 
Gout. 
201. 
5 Tr. Aloes c. Myrrha 3 ij. 
Ferri sulfurici gr. ij. 
Syr. Rhei arom. § iij. 
3 ij ter die. Gastro-intestin. 
(8 years.) Catarrh. 

202. 
IJ Extr. Colchici acetici 
Hydr. c. Creta ^ 3j. 
Extr. Colocynth.co. 3ij. 
F. pilulse 20. Chronic 
j hora somni. Diseases. 



203a. 

IJ Extr. Colocynth. comp. 

Sapon. med. ^ 3ij. 

01. Juniperi gtt. xl. 

F. pilulse 20. 

j bis die. Meteorismus. 

203b. 

IJ Extr. Colocynth. comp. 

Chin, sulfurici ^ 3j. 

Camphorae 3jv. 

F. pilulae 40. 

j ter die. Same. 

203c. 
IJ Extr. Colocynth. comp. 
Calomelanos ^ gr. vj. 
Pulv. antimon. gr. j. 
F. pilulae 3. 

S. hora somni. Congestive 
Dysmenorrhea. 
204a. 
IJ Extr. Colocynth. co. 3 ss. 
" Hyoscyami 3j. 
Mass. Hydrarg. gr. xij. 
F. pilulie 12. Constipation. 
j v.ij subinde. (pregnancy.) 



Golchicum (p. 48) combined with Salines is much 
employed where torpor of portal circulation in gouty 
habits. In Constipation from retained feces: Tinctur. 
gtt. v — x post cibum. 

Colocynthis is mostly used to unload the bowels m 
obstinate constipation; but it acts sometimes very 
violently, even in small doses, and in overdoses it may 
produce dangerous enteritis. Dose gr. v — x. It is 
usually given as pill. 

JPilulm Colocynthidis comp.: Extr. Colocynthid. p. 16. 
Aloes p. 50, Scammonium et Sapo T p. 14 
Cardamomum p. 6, Alcohol p. 10. 






CATHARTICS. 91 

204b. 206b. 

# Pil. Colocynth. comp. ^ Pil.Cambog.corap. 3 jss. 

" Galbani comp. a 3j. Chinini sulfurici 3j. 

Ferri oxydati gr. xij. p. pilule 30. 

Theriacae q. s. j sem el vel bis die. 

F. pilulae 12. Vulvar PJnterocele. 

ij bis die. Mastodynia. 20Y 

205. n - . I .. 

3 Elaterii gr. ij. 3 Glycerin* | q. _ 

Extr. Twaiwi gr. x. e . Kab , bitartanci 3] . 

F. pilulae 8. ^ as dose# Laxative. 

j tertiis horis. Dropsy. 208a. 

206a. ^ Calomelanos 3j. 

3 Pil. Cambog. comp. 3 j, Opii 3 ss. 

Mass. Hpdrarg. 3 ss. Tart, emetici gr. x. 

F. pilulae 30. Constipation. F. pilulae 40. 

ij subinde, (habitual.) j ter die. Hepatitis. 

Elaterinm is, perhaps, the most important of the 
hydragogues, being generally used in dropsical affec- 
tions, and also frequently as revulsive in cerebral dis- 
eases. Its action is no less violent than that of either 
Camboge or Colocynthis, and has proved even fatal in 
overdoses; but if administered in divided doses its effect 
can easily be regulated. In Bright's Disease, to prevent 
Uraemia, gr. 1-16 — \ hourly until purgation. 

Cambogia (Gutti) is also very violent in its action, 
andoverdoses have proved fatal. Itis usually employed 
in obstinate Constipation, combined with milder cathar- 
tics, in order to accelerate their action. 

Pil. cathartic, comp. — Extr. Colocynth. comp. 8.40. 

Abstract. Jalapae et Calomel 7 6.50. 
Cambogia 1.60.— Pilulae 100. 

Pil. Cambogice comp. — Aloes, Cambogia, Pulv. aroma- 
ticusjT2.5. Sapo5.0. Syr. simplex q. s. 
F. pilulae ponderis 0.15. Dose 2 — 4. 

Glycerin is more used as menstruum and nutritive 
than as laxative. See page 81, 



92 CATHARTICS. 

208b. 209b. 

]J Calomelanos gr. x. IJ Calomelanos gr. jv. 

Ipecacuanha gr. j. Jalapse gr. vj. 

Afterward Salts. Jaundice. Pulv. antimon. gr. j. 

208c. Afterwards Senna.- Dropsy. 

5- Calomelanos gr. vj. {after Scarlatina.) 

Rad. Rhei gr. xij. (5 years.) 

Later 01. Ricini. 210. 

Chlorosis. ^ Calomelanos gr. vj. 

209a. Fol. Digitalis gr. ij. 

IJ, Calomelanos gr. x. F. pilulse 2. 

Jalapae gr. xv. j hora somni. Anasarca 

Pulv. antimon. gr. ij. from gestation. 

Followed by Senna. To be followed in the morn- 

Epilepsy. ing by \ oz. of Salts. 

Jalapa is mostly used with Cream of Tartar (1:2) as 
Pulvis Jalapae compositus in cerebral and dropsical affec- 
tions; and with Calomel in bilious fever. It is a power- 
ful hydragogue, causing often much pain, and an overdose 
may produce dangerous hyperesthesia. The dose varies 
from gr. xv — xxx; in combination: gr. x. 

Mercurial Cathartics are frequently employed with a 
view of combining a purgative action with an increased 
flow of bile (many practitioners object to Mercury and 
use other drugs, especially Podophyllin instead), but are 
never administered without being followed by some 
other cathartic, to insure a full action. Calomel is given 
in doses of from gr. vj — xij, followed in 4 — -6 hours by 
\ oz. — 1 oz. of Salts, Senna or Castor oil; for children 
larger doses are required in proportion than for adults, 
gr. ij — vj being the dose for a child from 2—6 years old, 
though, generally speaking, Grey Powder is preferable 
in Pediatrics. Blue Pill is milder than Calomel, and 
forms, with Black draught, all over England a popular 
remedy for biliousness. 

In Suppression of Menses, Calomel gr. x, followed 
after 6 hours by Senna, or some other cathartic; in 



CATHARTICS. 93 

211. 213. 

IJ Massre Hydrargyri r> Olei Olivarum § vj. 

Sapon. med. ^ grs. xij. In one dose, or § ss half 

Asse fee ti das gr. vj. hourly after a day's fasting. 

F. pilulie 6. Constipation. Hepatic Colic. 

j vel ij h. s. (of pregnant s^) 2^ 

" ]J Podophyllin. gr. j. 
r> Hydrarg. c. Creta Spir. Vini Gallici 3j. 

Rad Rhei & gr. ij. Syr. sirnplicis § iij. 

Ipecacuanh. gr. 1-8. 3 j semel vel bis die. 

Con vulsions Gastro-intestinal 

from teething. (8 yea«s.) Catarrh. 

defective Menstruation at the climacteric period, with 
Jalapa (Xo. 209); in profuse Menstruation from undue 
lactation, with Rheum (Xo. 208.) In Constipation of 
children (1 — 4 years): gr. ij with jv — vj of Jalapa. 
Hydrargyrum cum Cre f -a gr. x — xij in Amenorrhcea, 
Palpitation from constipation, etc.; gr. jv in Paralysis 
for children of 1 — 2 years; gr. ij in Laryngismus stri- 
dulus from dentition (6 months); gr. j followed by 
Manna or Oleum Ricini 3 ss (5 weeks.) See section i. 

Oleum Olivce (Xo. 213) is said to facilitate the passag? 
of the gall-stones: The patient, after having swallowed 
the oil, should recline on the left side, with the hips 
higher than the shoulders. 

Podophyllin has a special determination to the upper 
part of the alimentary canal, and as it combines with its 
hydragogue property a decided cholagogue action, it is 
an excellent substitute for Mercury, especially in Func- 
tional Hepatic affections. As alterative it is occasion- 
ally of great service in Scrofula. 

Dose of Extractum fluidum: gtt. 20 — 3 ss=l. 0—2.0. 
Podophyllin: gr. \ — j = 0.015 — 0.065. (0.005 — 0.015 
for children of months to 4 years; 0.02: 5 to 14 years; 
0.03: over 14 years.) 



94 



CATHARTICS.\ 



215a. 
IJ, Extr. Frangulae fluidi 

Sodii Bicarbon. ^ 3 ij. 

Tr. Colombo 
velTr. Nuc. Vomic. 3j. 

Aq. Menthae ad § vj. 
| ss ter die ante cibum. 
(12 years.) Palpitation. 

215b. 
Pulveris Rheigr. x. 
Natri bicarbonici 
Saccharic Zj. « 
Olei Lavandulae gtt. v. 
Primo mane e cochlearibus 
duobus aquae sumendus. 

Constipation. 



216a. 
5 Extr. Rhei 3 ss. 
" Gentianae 3j. 
Sapon. med. gr. x. 
F. pilulae 20. 
ij bis vel ter die. 

Prolapsus Uteri. 
216b. 
5 Syrupi Rhei 20.0. 

" Sennae 10.0. 

Tr. Zingiberis 1.0. 

Aperient. 
21 7a. 
IJ, Olei Ricini 3 j. 
Tr. Opii gtt. j. 

For Infants. 



Rhamnus frangula is a mild acrid cathartic, similar 
to Rheum, but not so slow in its operation; thus proving 
a good and cheap substitute for the latter. The griping 
which it somtimes produces may be avoided by the 
addition of aromatics. Dose of Extractum fluidum: 
gtt. 20— 3 j = 1.0—4.0. 

Rheum is rather a slow cathartic; but it never causes 
inflammation of the alimentary canal. It is much em- 
ployed in cases of Diarrhoea, on account of its secondary 
astringent effect; and in Dyspepsia, on account of its 
stomachic and tonic properties. (See pp. 51 & 85.) As 
a mere cathartic it may be fully replaced by Rhamnus. 
Dose of root and fluid extract as stomachic laxative: gr. 
v — x; as purgative: 3j — 3 j; of Tr.: § ss — § j; and of 
Syrup: 3 j for an infant. No. 215b is said to be the 
most perfect combination of rhubarb; the lavender hides 
its flavor completely. 

Syr. Rhei; Extr. Rhei fl. 3 j; Tr. Cinnamomi 3ij; 
Pot.Carbonas gr.v; Syr. simplex § jv. 



CATHARTICS. 



95 



2l7b. 

ft Olei Ricini 6.0. 

" Terebinthinae 4.0. 
Acaciae 

Aq. fontanae ? 40.0. 

16 c. c.bihorio. Tympanitis. 
{Typhus.} 
218a, 
ft Magn. Carbonatis 
Rad. Rhei T 3 ij. 
Aq. Cinnamomi § viij. 
| ss omnimane. Inversion. 

218b. 
ft Magnes. c. Rheo gr, x. 

Aquae Foeniculi | ij. 
3 j ter die. Constipation. 
(3 months.) 

219a. 
ft Magn. sulfurics § j. 

Ferri sulfurici gr. viij. 
vel Acidi sulf. dil. 3 ss. 
Aq. Menthae § viij. 
3 j omni mane e cyatko 
aquae. Aperient and tonic. 



Vel: 

ft Magn. Sulphatis 
Pot. Tartratis ? § ss. 
Tart, emetici gr. j. 
vel Ferri Sulphatis gr. x. 
Aq. Fontis § viij. 
219b. 
ft Magn. sulf. 3 j — 1 ss. 

Chin, sulfurici gr. ij. 
vel Tr. Nuc. Vom. gtt. xv. 

Aq. fontanae § jss. 
Primo mane ex aqua. 

219c. 

ft Magn. sulfuric. 3 ij. 

Ferri sulfurici gr. vj. 

Acidi sulf. dil. 5 ss. 

Infusi Gentianae | vj. 

| ss bis die. Amenorrhoea. 

220a. 
ft Kali tartarici gr. xv. 
" bicarbonici gr. xij. 
Magnesiae gr. vj. 
Primo mane e cyatho aquae. 
Chronic Diseases. 



Castor Oil is perhaps the safest laxative used in gynae- 
cological and pediatric praxis, as it will open the bowels 
with the least possible irritation; hence its value in 
inflammations about the abdomen and pelvis; in affec- 
tions of the rectum and womb; in Pregnancy, Hernia, 
Typhus, etc. Dose | ss — § j; children: 3 j — 3 ss. 

In habitual Costiveness occasional massage or several 
articles of diet, which have a laxative property, will be 
frequently of assistance: oatmeal, bran, molasses, honey, 
and particularly ripe or dried fruit, as apples, prunes, 
tamarinds, etc. 

Salines: Magnesia (p. 52,) though laxative, is gener- 
ally used as antacid, and mostly in pediatrics. Dose as 



96 



CATHARTICS. 



220b. 
5 Potass. Tartratis 3j. 

Jalapae gr. xij. 
Vel: Tympanitis. 

JJ Pot. Bitartratis 3 ij. 
Jalapae 3j. Dropsy, 

(to prevent Urcemia.) 
220c. 
IJ, Kali bitartarici 3 vj. 
Extr. Digitalis fl. 3 ss. 
Aq. fontanae 5 vj. 
§ j ter die. Pleuritis. 

(if effusion. ) 
221. 
5 Sodii Sulphatis 10.0- 
Extr. Taraxaci fl. 5.0. 
Aq. destillatae 50.0. 

Syrupi Rhei 25.0. 

4 c, c. bihorio. Icterus 

Neonatorum. 



222. 
r> Sodii Phosphatis 
Mannae T 3 j. 
Aquae Foeniculi § j. 
3 ij ter die. Constipation. 
(3 years.) 

223a. 
r> Foliorum Sennae 
Semin. Anisi a § j. 
Aquae bulliente Oj. 
Colaturae adde 
Pot. Bitartratis § j. 
§ jss every morning before 
breakfast. 

223b. 

5 Inf. Sennae comp. § jss. 

Spir. Nuc. Moschat. | j. 

Syrupi Rhei § ij. 

| ss ter die. Prolapsus 

Vaginae. 



laxative: 3j ex aqua vel lacte. Magnesii Sulphas 
(Magnesia sulfurica) is a mild refrigerant purgative, 
generally used with Senna. Dose § ss — § j. With 
Ferrum and other tonics (No. 209) it is of service in 
chronic diseases — ulceration of cervix uteri, Cervical 
Endometritis, Engorgement of breast, etc. — to drain the 
congested abdominal veins and to brace the system. 
Potassii Pitartras (Kali bitartaricum) is in doses of 
3 j — 3 ij a gentle diuretic and refrigerant aperient, 
useful in fevers; in doses of § ss — § j it has hydragogue 
properties, and is frequently used in Dropsies. Potassii 
Tartras, though similar to Cream of Tartar, is much less 
used: No. 220a, especially if the urine red. (Like Pot. 
Acetas both salts change in the stomach into carbonates. 
See page 53.) Potassii et Sodii Tartras (Tartarus 
natronatus) is generally employed in the form of Seid- 
litz powder, and well adapted to gouty habits and cases 



CATHARTICS. 



97 



223c. 
r> Extr. Sennse fluid. 
Magn. sulfur. 7 3 ij. 
Tr. Jalapre 
Manure ^ 3 j. 
Aq. fontanse § jv. 
Vel: After Calomel, 

t} Extr. Sennas fl. 
Magn, Sulphatis 
Tr. Jalapae 7 3 j. 
Aquoe Fontis § ij. 
(5 years.) 

223d. 
rj Extr. Sennae fl. 3 ss 

" Frangulas fl. 3 ij. 
" Gentian, comp. fl. 
Sodii Bicarbon ^ 3 j. 
Aq. fontanre 3 vj. 
3 ss ter die ante cibum. 

Gastro-intestinal 
Catarrh. 



Vel: 

IJ Extr. Sennse fl. § ss. 
Ammonii chlorati 3 j. 
Aquae Anisi § vj. 
1 ss ter die ante cibum. 
[If there be Jaundice.) 
223e. 
^ Extr. Senna? fl. 3ij. 
M Frangulaa fl. 3j. 
" Gentian, comp. fl. 
Natri bicarbonici ^ 3 ss. 
Aquae Anisi q. s. ad § ij- 
3 j ter die ante cibum vel 
tertiis horis. (2-5 years.) 
224a. 
tj Sulfuris depurati 20.0. 
Kali bitartarici 
Sacchari albi ^40.0. 
Oiei Citri gtt. j. 
3 j ter die ex aqua. 

Hemorrhoids' 



of uric acid diathesis; but it should not be given in the 
phosphatic, as it renders the urine alkaline. Sodii Sul- 
phas (N"a # trum sulfuricum) is similar to Magn. Sulphas, 
but more bitter, and perhaps more nauseous. Sodii 
Phosphas is, on account of its agreeable taste, well 
adapted to all cases of children and delicate persons, 
especially where there is a deficiency of phosphor, and 
saline matter,it being a constituent of thebloodin health. 
Dose 15.0 — 50.0; in Constipation, with red urine, 3 iij 
every morning ex aqua. See page 57. 

Senna is a prompt and efficient cathartic, acting on 
the entire track of the intestinal canal, and producing 
watery feculent stools; hence its use in febrile and in- 
flammatory cases. The addition of bitters promotes its 
activity, and its tendency to gripe may be avoided by 
aromatics or neutral salts. Dose of Extractum fluidum, 



98 



CATHARTICS. 



224b. 
g, Sulf. praecipitati 3j. 

Magnesiae 3jv. 
Divide in partes 4. 
j hora somni ex aqua vel 
lacte. Same, 

225a. 
9, Olei Tiglii gtt. ij. 
Ipecacuanhae gr. ij. 
Calomelanos 3j. 
F. pilule 10. Amenorrhea. 
j quartis horis. 

225b. 
r> Olei Tiglii gtt. vj-viij. 
Sacchari albi 3 j. 
Aquae fontanae 3 ij. 
Pars semis, and in 3 hours 
the rest, if necessary. 

Coma (if pulse strong). 



225c. 




5 Olei Tiglii 


0.1. 


Sacchari albi 


10.0. 


AcaciaB 




Tr. Card. comp. 


a 2.0. 


Aq. destillatae 


60.0. 


4 c. c. several times 


daily. 


Meningitis. 



226. 

5- Saponis Tiglii gr. vj. 

Pil. Colocynthidis 

c. Hyoscyam. gr. xxjv. 

Calomelanos 3 ss. 
F. pilulae 12. 
j bis vel ter die. Epilepsy 

from suppressed Menses. 
(With Magn. sulf. 3 j every 
morning). 



2.0— 8.0 bis vel ter die; 0.3 — 1.0 bihorio. In Constipa- 
tion of pregnancy: Electuarium e Senna 3 j — 3 ij bis die. 

Sulfur is a mild laxative, having at the same time a 
gentle stimulating property to the skin and mucous 
membrane; hence its value in chronic cutaneous dis- 
eases. Dose, 3 j — 1 ss in treacle or milk. The choice 
between Sulfur depuratum and Sulfur j>raecipitatum 
is a matter of taste, there being no difference in their 
effects. 

Croton Oil is, from the speediness of its action, still 
more than from the smallness of the dose required, a 
most valuable purgative in cerebral disorders, especially 
Coma. Even an external application to the abdomen — 
mixed with 01. Olivarum — will produce catharsis. Occa- 
sionally it is used in obstinate Constipation. The dose 
is gtt. j — ij, though sometimes as much as gtt. viij — x 
may be taken without affecting the bowels. 



SECTION VII. 



EMETICS 



Remove not only Indigesta and otherwise deleterious 
substances from the stomach, by exciting that viscus to 
discharge its contents through the mouth, but expel 
also foreign bodies if lodged in the throat or oesophagus. 
They, moreover, relieve spasm, promote perspiration 
and expectoration, and assist in the removal of obstruc- 
tions in the viscera generally. 

Alumen. 

axtimoxii et potassii tartras. 

Apomorphinum. 

Cupri Sulphas. 

Htdrargyri Subsulphas flavtts. 

Ipecacuanha. 

Sin apis. 

Sodii Chloridum. 

Zixci Sulphas. 

Emetics are contra-indicated in Congestion of the 
Brain, Hernia, Pregnancy, etc. 



loo EMETICS. 

227a. 228a. 

5 Ipecacuanhas gr. xv. IJ Cupri sulfurici 1.0. 

Tart, emetici gr. j — ij. Sacchari Lactis 5.0. 

Dentur tales doses 3. Divide in partes- 10. 

j every 15 minutes until j every 15 minutes until 

emesis. emesis. 

227b. (3-7 years.) Croup. 

IJ Ipecacuanhae gr. jv. 228b. 

Tart, emetici gr. ^. tj Cupri sulfurici 1.0. 

With warm water. Aq. destillatae 40.0. 

(3 years.) Scarlatina. In 2 doses within 15 min. 

( if throat stuffed. ) Opium poisoning. 

Ipecacuanha is the emetic in all cases where a simple 
evacuation is required, mild and sure, and therefore well 
adapted in spasmodic Group, acute Bronchitis of chil- 
dren, etc. The vomiting is promoted by the free use 
of tepid water; if excessive, it must be checked by de- 
mulcents, opiates and counter-irritation. 

Dose, gr. xv — xx; as nauseant, gr. \ — ij ter die; as 
diaphoretic and expectorant, gr. \ — \\ and as tonic, gr. 
1-10 ter die. (p. 82.) The fluid extract 3 ss — 3 j; Vinum 
Ipecacuanhae | ss — § j; Syrupus Ipecacuanhae 3 ss — 3 j 
for children of 1 — 2 years; gtt. v — xx as expectorant. 

In commencement of Cholera: Pulv. Ipecacuanh. gr.vj 
(6 years.) In Fits: gr. iij — v (2 years.) 

Vinum Ipecacuanhas: Extractum fluidum 1.25. 
Vinum ad 20.0. 

Syrupus Ipecacuanhas .• Extr . fluidum 1.0. 

Syrupus simplex ad 20.0. 

Antimonii et Potassii Tartras (Stibio-Kali-tartari- 
cum — Tartarus stibiatus s. emeticus) Emetic Tartar 
is very valuable in Parturition if os rigid, and the skin 
hot and dry. See page 23. 

Vinum Antimonii (Vinum stibiatum) 1:250 Vinum. 

Cupri Sulphas (pp. 65 & 11) — gr. v — x in poisoning 
by Opium; 1.0 in poisoning by Potassii Cyanidum. 

Alumen (pp. 62 & 63): Dose as emetic, gr. viij — xxx 



EMETICS. 101 

= 0.5 — 2.0. Teaspoonful ( 3 ss) in Croup; tablespoonful 
in poisoning with Opium. 

Apomorphinis especially valuable where insensibility- 
prevents the administration of an emetic by mouth. See 
Hypodermic Medication, chapter it. 

Hydrargyri Subsulphas flavm (Hydrargyrum sulfuri- 
cura). Gr. iij — v of Turpeth Mineral is sometimes used 
in true Croup. 

tiincqris is especially useful in atonic conditions of 
the stomach. Dose 3j — 3 i j = 4.0 — 8.0. One tea or 
tablespoonful in poisoning by Opium. 

Sodii Chloridum (p. 57.) A tablespoonful of salt in 
warm water in Alcohol poisoning. 

Zincl Sutyhas (p. 86) is perhaps the most reliable 
emetic in cases of narcotic poisoning. Dose, gr. xx — xxx. 



SECTION VIII. 



VERMIFUGE 

Destroy certain parasites in the human body, by either 
an antiseptic and inherent vermicidal power, or by in- 
vigorating the intestinal canal; and thus preventing the 
accumulation of mucous and slimy matter, without which 
these animals cannot exist. 

Agents which destroy the round worm (Ascaris): 
Cinchonidinum, Naphthalinum, Santoninum and 
Spigelia. 

The following either expel or kill the tapeworm 
(Tcenia) : Aspidium (Filix mas), Chloroform., Cuprum 

OXYDATUM NIGRUM, GRANATUM (PUNICA), PePO (CuCUR- 

bita), Phenolum, Terebinthina, Thymolum. 

In Trichinosis (Trichiniasis) have been successfully 
used Benzltstum & Salicinum. 



VERMIFUGJE. 



103 



229. 
5 Cinchonid. tannici 

Ferri oxyd. hydr. ^1.0 
Divide in partes 10. 
j hourly during forenoon. 
Ascarides. 
230. 
r> Santonini 

Sacchari albi ^ gr. iij. 
Dentur tales doses 12. 
j ter die. Same, 

231. 
IJ, Rad. Spigeliae gr. vj. 

Calomelanos gr. jv. 
Followed by Oleum Ricini. 
(10 years.) Chorea 

from worms. 
Vel: 
§, Rad. Spigeliae | ss. 

Foliorum Sennae 3 ij. 
Fiat Infusum | jv. 
| ss bis die. (4 years.) 



232. 
r> Acid, carbol. gtt. viij. 
Glycerin ae § ij. 
Aq. Fontis § vj. 
§ ss — | jhourlyforoneday, 
followed by a cathartic. 
Taenia. 
233. 

g, Cupri oxydati nigri 6.0. 

Calcariae carbonicae 2.0. 

Boli albi laevigat. 12.0. 

Glycerinae 10.0. 

F. pilulae 120. 
ij quater die for one week, 
then iij each time. Same. 

234. 
^ 01. Filic. maris 3 j. 

Mucil. Acacias q. s. 
Fiat Emulsio. 
Sumatur hora somni e lacte. 
Same. 



Cinchonidinum tannicum cum Ferro (p. 11) is an 
excellent remedy in round worms; but the pin worm 
is more easily destroyed by appropriate enemata followed 
by tonics. (Nos. 3 70 & 377.) The dose is gr. iij — xxx 
=0.2— 2.0. 

Napthalin (p. 15) has been recommended in doses of 
from 3j — jv per diem; for children under 3 years 
gr. ij — iij bis die. Also as taenicide. 

Santoninum (Santonina) in strong doses produces 
thoughtlessness and chromatopsia in weak children; 
and 0.5 may kill. (p. 6.) It should be followed always 
by a brisk purgative. Maxim, dose: 0.1; 0.5 per diem; 
2 doses of 0.025 each during forenoon to child of 1 or 2 
years; 3 doses in the same space of time to child of 



104 VERMIFUGE. 

Vel: Vel. 

^ Extr. Filicis aetherei g, Emuls. Sem. Cucurbit. 
" Granat. C. Rd. (ex § ij parat.) % viij. 

^ 2.5. This dose several days in 

Cort. Had. Granatiq.s. succession. Same. 

F. pilulae 40. Lycopodio Vel: 

conspergantur. IJ 01. Terebinthinae § ij. 
iij after a milk-breakfast. Mucil. Acaciae § ss. 

235. Aq. fontanae q. s. 

5 Dec. Granati Cort. Rd. Fiat Emulsio § vj. 

(ex | ijss) | xij. Tr. aromaticae 3 ij. 

In the course of the fore- Pars quarta every half hour, 
noon. Same. Same, 

3 or 4 years; 2 doses of 0.05 each during forenoon: 5 or 6 
years; 3 doses — 7 or 8 years. 

Spigelia should also be followed by a brisk purgative. 
Dose of Extractum fluidum: 3 j — 3 ij=4.0 — 8.0. Extr. 
Spigeliae c. Senna fl. § ss ter die. 

Acidum carbolicum (p. 16.) Dose gr.-J— iij=0.032-0.2. 

As the worm is nourished by the contents of the 
small intestines by endosmosis, no fat nor farinaceous 
food should be given; only beef tea freely. 

Aspidium Filix mas — The oleoresin is more effective 
than the extract; but no dinner or supper must be taken 
to obtain a good effect of the oil. The practice of giving 
the remedy for tapeworm to fasting patients has lately 
been condemned. Its administration cne hour or two 
after a full meal is said to be at least as effective and 
decidedly less irritating to stomach and intestines. Dose 
of the oil, gtt. 15 — 30 =1.0 — 2.0; of the extract, gtt. 
10—20 = 0.65—1.3. 

Cuprum oxydatnm nigrum is said to kill the worm 
without producing the slightest inconvenience to its 
victim; but during the time that the pills are taken, acid 
drinks must be avoided. 

Granatum — The bark of the root has never failed in 
my hands, but it must be fresh, and I took care to have 



VERMIFUGJE. 105 



236. 


237. 




IJ Benzini 3 ij. 


IJ, Acidi salicylici 


10.0. 


Succi Glycyrrhiza3 


Solve in 




Mucil. Acaciaa ^ § j. 


Alcoholis puri 


iooo.'o. 


Aq. Menth. q. s. ad § vj. 


Turn adde 




3 ss omni hora vel bihorio. 


Olei Carvi 


2.5. 


Trichinosis, 


Tr. aromaticae 


50.0. 


Vel: 


Syr. simplicis 


950.0. 


IJ, Benzini 3 j. 


32 c. c. after having eaten 


Glycerine § viij. 


pork suspected to 


contain 


5 ssomni hora vel semihora. 


Trichinae. 





the root dug in my presence. Dose gr. xv — 3] = 1.0 
— 4.0; of Extractum fluidum gtt. xx — xc = 0.65 — 3.0. 
(If there be any doubt about the freshness of the root 
Pelletierine should be taken.) 

Ol. Terebinth. 3 ij bis die for 2 days, followed by 
Oleum Ricini § ss and to be repeated in 4 hours unless 
the bowels open freely, to child of 5 years. See page 68. 

Chloroform (p. 30) has been given in doses of gtt. 30 
half-hourly; or in 3] dose before breakfast in conjunc- 
tion with Ol. Ricini et Tiglii (gtt j: § j). 

Thymol (p 19) is recommended as a perfectly safe 
remedy for tapeworm, if its depressing effect is counter- 
balanced by a simultaneous administration of brandy or 
some other stimulant. It is exhibited in gr. x doses 
every 15 minutes until 3 ij are taken, the last dose to 
be followed by some cathartic. It appears, however, 
that Acidum thymicum may be completely replaced by 
Acidum salicylicum. See page 16. 

Benzin (p. 45) may be given in doses of 0.065 — 0.65. 



CHAPTER II. 



HYPODERMIC MEDICATION. 

The nature of the remedies used in Hypodermic 
Medication prevents this form of administering medi- 
cines from overstepping certain limits in the art of heal- 
ing; yet in many cases where we can avail ourselves of 
it, we must confess that it is an invaluable auxiliary. 

The great advantage of subcutaneous injections lies 
not only in the rapid absorption and consequent imme- 
diate action of the remedy on the system, but still more 
in the fact that they may be employed with the full 
effect of the remedial agent, where absorption from the 
stomach is altogether out of question on account of its 
irritability, as in pernicious fevers, cholera, etc., and last, 
but not least, where the condition of the patient pre- 
cludes the exhibition of a medicine in any other way, as 
in cases attended with more or less insensibility of the 
sensorium. 



HYPODERMIC MEDICATION, 107 

238. Solut. Acidi arseniosi 1 per cent. gtt. iij — v. 
vel Sol. Fowleri p. j; Aq. dest. p. ij. 0.6 — 1.0 during 
the fit. Asthma, (p. 11). S — 10 injections suffice. In 
Chorea gtt. iij for child of 4 — 7 years, every other day; 
gtt. v: 11 — 14 years. (15 — 20 injections per month.) 

239. Solut. Acid, carbol. (1.0) 30.0; 1.0 as injec- 
tion. (Superior to Quinine?) Intermittens, (p. 16.) In 
Acute Rheumatism [articular), Lumbago and Erysipelas, 

one syringeful near the affected joints once a day of a 
2 per cent, solution. A parenchymatous injection of 
the same strength is employed for inflamed glands and 
all kinds of tumors. 

240. Apomorphin. hydrochlor. 0.12; Aq. dest. 10.0. 
Per pen ic ilium Ian re vitreae funde (1.0 = 0.012). One 
syringeful (0.005) during the aura. Epilepsy. Aside 
from being shortened, the paroxysm, if it should re- 
appear at all, will be extremely mild — perhaps only a 
fainting — which may be ultimately cured by using later 
about 0.0025. (?) 0.006 — 0.012 in Croup or Diphtheria. 
Solutio Apomorph. (gr. j) 3 ijss. Dose, min. v — xx. 
Being a prompt emetic, it is especially valuable where 
insensibility pre cents the administration of an emetic 
by mouth. See sections in & vn. 

A successful use of the hypodermic syringe is only to be 
expected if the following rules are borne in mind and acted upon : 

1. The remedial agent has to be of the greatest purity, 
hence the necessity of using fresh solutions. The menstruum 
may be distilled water, or, what is as good, filtered rainwater. 
If, however, we wish to keep a solution for some time. Bichloride 
of Mercury in the proportion of 1:5000 as menstruum is sure to 
prevent decomposition? (Bv employing Sol. Hvdr. bicblor. 
[0.1] 500.0, vfe have in 8 drops 0.0001, or l-6( grain.) Moreover, 
the solution should be perfectly neutral and always filtered, and 



108 HYPODERMIC MEDICATION 

241. Atrop. sulf. gr. j; Aqua pura 3 xv. (10 min.= 
1-90 gr.) Dose, min. v — xx. Gr. 1-90 in Congestion of 
the brain (feeling like a tight band round the head, heavy 
breathing, eyes bloodshot, etc.) Gr. 1-30 every half hour 
in poisoning by Opium, (p. 23.) For Atrop. cumMorph. 
see No. 255b. 

242. Caffein. gr. x; Alcohol & Aq. dest. ana 3 jss 
(1 min.= gr. 1-18). Dose, min. jv — xviij 

243. Camphora gr. v; Alcohol 3 j. Dose, min. vj — 
xxx. See section n. 

244. Chinin. bisulf . 3j; Acidum boracicum gr. ij; 
Morph. gr. J; Aq. dest. § j. Gtt. viij=gr. j. The effect of 
Quinine hypodermically is about four times greater than 
when taken by mouth, and in this composition the risk of 
abscesses at the place of injection is rendered like nil. 
The Carbamide (1 — 2:10 Aqua) is said to produce neither 
an irritating effect. 

245. Chloral, pars j; Aq. pura partes ij. Dose, min. 
viij — x. Hestlessness. See page 30. 

there will be no danger of inflammatory swellings or abscesses 
about the part where the injection has been made. 

2. The injection should be made where there is the most 
abundant supply of cellular tissue — abdomen, arm, thigh, back 
and calves of the legs; and in case of repetition, another spot 
should be chosen, to prevent irritation of the part. (Bony pro- 
minences, inflamed parts and veins are to be avoided.) 

3. Before making the puncture, the air contained in the 
syringe should be expelled, by everting the instrument and 
pressing the piston just far enough to have at the needle's point 
a show of the liquid employed. 

Lastly, having at the place selected drawn up the skin in a 
tense fold with two fingers, the needle should be thrust as far 
as possible into the subcutaneous tissue, and the remedy very 
slowly injected. After withdrawing the needle, it is well to 
apply the finger over the puncture for a short time, to prevent 
any escape of the liquid injected. 



HYPODERMIC MEDICATION. 109 

246. Chloroform, min. v — x in Neuralgia, Nervous 
Excitement, Morbus nauticum. See section n. 

247. Cocain. gr. j; Aq. dest. gtt. x bis die. Alco- 
holism. (Effect within 5 minutes.) In smaller doses it 
is employed in Melancholia, Insanity, Chorea gravior, 
Spinal Irritation, etc. See pages 77, 112 & 115. As 
anaestheticum gtt.viij of a 4 per cent, solution injected at 
the anterior and the same quantity at the posterior base 
of the tumor. Sebaceous Cyst. (After 25 minutes a 
linear incision may be made and the sac pulled out). 

248. Coniin.O.i; Alcohol 10.0; Aq. dest. 40.0. One 
syringeful(=1.0=0.002). ( This dose doublets the strong- 
est to be admitted.) Asthma, Convulsions, Neuralgia. 

249. Daturin. gr. ss; Aqua § j. Dose, min. jv — x. 

250. Digitalin. gr. ss; Alcohol, Aq. dest.T 3 ij. Dose, 
min. jv. — viij vel Tr. Digitalis min. x. Insolatio. (p. 50.) 

251. Duboisin. sulf. 0.05; Aq. dest. 20.0. 0.1—0.3 
(=0.00025 — 0.00075) as injection. Strongest dose: 0.4. 
Antidote to Pilocarpin. See Hyoscyamus. (p. 33). 

252. Ergotin. gr. xv; Alcohol & Glycerin. ? 3 ijss. 
Dose, min. v — xxx. (min. 1 = 1-20 gr.) Extr. Ergotae 
fluidum min. x. (p. 65). 

253. Sol. Ferri citr. 10 per cent., gtt. xv daily in 
Chlorosis (if irritable stomach). 

254. Hydrarg. bichloratum 0.25 — 0.5; Aqua pura 
& Glycerin. ? 15.0. Once every third or fourth day in 
the arm. Syjihilis. 

255a. Sol.Morph.Magendie gtt. x every 8 or 12 hours 
in Dysmenorrhoea. In Hematocele, if there be great 
prostration, it may be repeated in-J- hour if it fail to give 



HO HYPODERMIC MEDICATION. 

relief. In Cellulitis, Uterine Colic, Pelvic Peritonitis, 
etc. Morphium gr. 1-5 in Gastralyia, etc. In Cholera, if 
it has been rejected by mouth. See page 38. 

255b. Morph. sulfur, gr. xxjv; Atropin, gr. j; Ol. 
Amygdal. am. seth. gtt. j; Aqua pura § ij. min. x = 
Morph.gr. \. & Atropin. gr. 1-96. Morphin. c. Atropin. 
is usually dosed in proportions of gr. J: 1-100 — gr. -J: 
1-120— gr. J: 1-150— gr. 1-6: 1-180— gr. |: 1-200, etc. 

256a. Physostigma. The Calabar bean has been em- 
ployed with good effect in Trismus Neonatorum: gtt. 
j — v of Sol. Extracti (gr. ijss: 3 j). 

256b. Pilocarpin. gr. 1-5; Aqua gtt. x. 2 — 3 minutes 
after the chill has fairly begun. Intermittens. Pilo- 
carpin gr. -J- — 1-6; Aqua gtt. x. See Jaborandi, page 50. 

257. Strychn. nitricum 0.06; Aq. dest. 7.5. \ syringe- 
ful near the sacrum. Enuresis nocturna. (2-4 injections 
are sure to cure?) Strychn. nitr. 0.1; Aq. dest. 20.0 
(1.0=0.005); velAq. pura 12.5 (1.0=0.008). Strychnin, 
nitricum gr. ss; Aqua dest. § ss. Dose, min. jv — xv. See 
Nux Vomica, section v. 

258. Veratrin. 0.1; Acidum aceticum dil. gtt. xij; 
Alcohol. 2.0; Aq. dest. ad 20.0. See section n. 0.25 — 0.5 
— 0.75 to be injected. (0.00125 — 0.0025 — 0.00375). 
Puerperal Convulsions. 

259. Woorara O.lr'Aq. dest. 10.0. Funde per lanam 
vitream. To begin with 0.15 to 0.2. Epilepsy. Woorara 
0.3; Aq.dest. 5.0; Acid, hydrochlor. d. gtt. j. For eight 
injections. Blepharospasms. Woorara gr. j; Aq. 3 iij. 
Dose, min. v — x. (In Hydrophobia 0.2 have been in- 
jected within five hours with success). It may be used 
until relaxation of muscles ensue. See Curare, section n. 



CHAPTER III. 



TOPICALS 

Act chiefly locally, though some of them, by being ab- 
sorbed, will affect organs more or less remote from the 
place of application. 

DISEASES OF EYE AND EAR. 

260. Solutio Acid, borac. (1.0) 30.0. Conjunctivitis 
purulenta. Acidum boracicum pulv. applied once a day 
to the lids with a camel's hair brush is excellent in 
Granular Lids and Trachoma; it is also used in indolent 
Ulcers of the Cornea. A saturated solution of Boric 
acid (4 per cent.) is sometimes used as menstruum for 
Cocaine and other Alkaloids. 

261. Solutio Argenti Nitratis (0.03) 15.0. Detur ad 
vitrum nigrum. Gtt. j to be dropped into the inner angle 
of the eye bis vel ter die. Conjunctivitis catarrhalis. 
0.15:15.0 Aqua: To be applied once a day with a camel's 
hair brush, and to be immediately wiped off with another 
brush dipped in a solution of Sodii Chloridum. (The 
surplus of the caustic is thus made inert, forming Argenti 
Chlorid. which is insoluble). Gonorrhoeal Ophthalmia. 
(If the inflammation be severe, two or three leeches 



112 TOPIC ALS: 

should be applied to the inner angle of the eye or to the 
temples and a cathartic given. In case of pain, warm water 
compresses, with laudanum, over the eye will be useful, 

262. Atrop. purum0.05: Aq.dest. 150.0. To apply to 
corneaevery three hours. Iritis. Atrop. 0.05 — 0.2; 01. 
Ricini 30.0. Keratitis. Atrop. sulf. 0.05 — 0.08; Aqua 
destillata 10.0. vel Atrop. 0.1; Glycerol, simplex 20.0. 
vel Atropin. 0.01; Glycerin. 5.0; Aq. dest. 10.0. vel 
Atrop. purum 0.1 — 0.15; Acid, salicylicum 0.05; Aqua 
dest. 20.0. Collyrium stillatitium. 

263. Cocain. gr. v; Atrop. gr. ss; Ungt. Petrolei 3 ij. 
To be applied with a camel's hair brush. Ophthalmia. 
(To relieve pain). Solutio Cocaini hydrochlorati 4 per 
cent. gtt. j — ij to the inner angle of the eye at intervals 
of three minutes, as anaesthetic, for the removal of for- 
eign bodies from the cornea. The effect is produced 
within ten minutes. (A lens of 3-inch focus is required 
by some for the operation, which is performed best by 
means of a cataract needle.) See page 115. 

264. Extr. Conii 2.0. Aqua -destillata 1.0; Glycerol- 
atum simplex 20.0. To rub around the eye. Photophobia. 
Coniinum 0.01; Alcohol dilutus 1.0; Aq. destillata 12.5. 
JBlepharismus (scrofulous). 

265. Duboisin. sulf. 0.05— 0.08; Aq. destillata 15.0. 
Collyr. stillatitium. (For dilating the pupil it is quicker 
in action than Atropin. See Hyoscyamus, page 33.) 

266. Hydrargyrum amidato-chloratum 0.25 — 0.35; 
Unguentum simplex 5.0. Applicatur bis vel ter die. 
Blenorrhoea palpebrarum. Ungt. Hydrarg. rbr. (1:8) 

3 i. Ungt. Cetacei 3 ij; vel Hydr. oxyd. rbr. gr. j; Zinc. 
sulf.gr. ij; Ungt. simplex 3 ij. Ophthalmia Tarsi. 



Diseases of Eye and Ear. 113 

267. Hydrarg. bichlorat. gr. j; Ammon. chlor. gr. iv. 
Aqua 3 vj. Apply three times a day. Ophthalmia 
Neonatorum. Conjunctivitis scrophulosa. 

268. Calomel is dusted over the affected part with a 
camel's hair brush. In Conjunctivitis phlyctenulosa 
Macula Cornece, etc. See Iodine, page 14. Hydr. oxyd. 
rbr. gr. xv; Tutia gr. vi; Adeps3ij. To be smeared 
in the edge of the lid night and morning. Albugo. 
Lencoma. 

269. Iodoform., Balsamum peruvianum T f. o. Ungt. 
Petrolei 4.0. Conjunctivitis, Keratitis. Iodol. 3 j, Ungt. 
Petrol. | ss. Chronic Conjunctivitis. Iodoform or Iodol 
dusted over the sore has been lately usedin Ulcus Cornece^ 
(Iodol is the inodorous substitute of Iodoform, and is 
said to be superior to the latter. It may be used on 
tampons for abscesses, etc., in most cases where Iodo- 
form is indicated. See No. 280). 

2 TO. Physostigmin. purum 0.01; Sol. Acid, boric. 4 
per cent. 100.0. vel Eserin. salicylicum 0.1; Aq. dest. 
30.0 — 50,0. To effect myosis. Iritis. Physostigmin 
like Muscarin causes myosis and ptyalism. (Antidote: 
Belladonna, as in Poisoning by Mushrooms .) 

871. Strychnin, nitricum 0.1; Grlycerina 10.0. vel 
Strychn. purum 1.0; 01. Amygdalarum 12.0. Gtt. xv 
— xx bis die over the eye or forehead. Amaurosis. 

272. Veratrin. 0.5 — 1.5; Alcohol. 30.0. Amaurosis, 
Amblyopia, Neuralgia, etc. 

2 73. Spiritus Yini Gallici 3 ss; Aq. § iij. Collyrium. 
Liq. Plumbi gtt. xv; Liq. Opii sedat. 3 j; Aq. dest. 5 vj; 
vel Sol. Zinci sulf. (gr. j) % j. Alumen, Cuprum sulfurr 
cum,Zincum aceticum (gr. j: 5 j) make also good coHyria. 



114 TOPIC ALS: 

274. Acid, carbolicum gtt. x; 01. Succini gtt. v; 01. 
Hyoscyami 5.0; 01. Olivarum 30.0. Guttas aliquot ad 
aurem bis die. Partial Deafness, Otalgia, Otorrhcea, 
Ulcus, etc. Acid, salicylicum 2.0; Alcohol. 40.0. Aq. 
dest. 60.0. Applicatur bis die ad aurem. Otorrhcea. 

275. Pulvis Aluminis blown in the auditory passage 
once a day is of great value in Otorrhoea with Fungoid 
Growth. 

276. Solutio Atrop. (0.03:15.0) gtt. iij — v dropped 
into the ear and allowed to remain there for 10 — 15 
minutes. Otalgia, especially nocturnal. (Child under 
3 years; when over 10 years 0.1:15.0.) Chloral, Cam- 
phora 3ij; Glycerin. 3 iij; 01. Amygdalarum 3j. On 
cotton. Otalgia. 

277. Aq. Calcis & Lac ? f j; Tinct. Myrrhae gtt. xij. 
Otorrhoea (inflammatory). 

278. 01. camphoratum 5.0; 01. Cayeputi 2.5. Partial 
Deafness, Rheumatic Otalgia. 01. Camphorae 15.0; 01. 
Amygdalarum 30.0; Liquor Ammon, anisatus gtt. viijo 
Hypocophosis asthenica, etc. 

279. Ungt. Hydrarg. nitric & 01. Amygdal. ana in 
Chronic Inflammation of the auditory canal in children, 
after cessation of discharge. 

280. Iodol. 25.0; Glycerin. 100.0. Acute Otitis. 
See preceding page, No. 269. 

281. Sol. Zinci sulfurici 0.05:25.0. Otorrhcea. Sol. 
Potass. Permanganatis 0.1:25.0 (if fetid discharge). 

282. Tr. Opii2.0; 01. Olivarum 8.0. Otitis externa. 
(Besides an emollient poultice — onion or poppies — over 
the ear, and if necessary two or three leeches round the 
mastoid process, and perhaps a brisk cathartic.) 



Diseases of Air Passages, eic. 115 

DISEASES OF THE AIR PASSAGES AND 
ADJACENT PARTS. 

283. Tinctura Catechu 20.0; Tr. Cinnamomi 10.0; 
Aq. Menth. spirituosa 150.0. 16 c. c. with water as 
mouth-wash. Tr. Catechu, Tr. Cinnamomi, Tr. RatanhaB 
7 25.0; Tr. Chime 10.0: Tr. Myrrh as 15.0; Spir. Coch- 
lear. 50.0; Bals. peruvianum 1.0. vel Tr. Catechu 80.0; 
Tr. Guayaci, Tr. Ratanh. £ 40.0; Tr. Caryophyll. 30.0; 
Tr. Myrrh. 160.0; Spir. Cochlearise 20.0; Ol. Cinnamom. 
gtt. xx; Ol. Rosarum gtt. j; Alcohol & Aqua ~ 315.0. 

284. Borax et Saccharum, ana. A little on tongue 
bis die. Stomatitis. (I use invariably a watery solution, 
without either saccharum or mel.) 

285. Solutio Cocaini 4 per cent, rubbed on the gums 
twice within three or four minutes will quiet an infant, 
produce sleep, and even stop diarrhoea. Teething. On 
absorbent cotton, or applied with a camel's hair brush to 
the mucous membrane of nose and fauces, it is employed 
in Catarrh and Hay Fever. (In the asthmatic form it is 
useless, and better to have at once recourse to Lobelia, 
Chloroform, Nitre fumigations or inhalations of seda- 
tive preparations.) Cocaine applied to the pharynx in 
Hysterical Vomiting frequently gives prompt relief. 
See pages 11 & 109. 

286. Hydrargyrum bichloratum 0.5; Glycerin. 50.0. 
Syphilitic Ulcers, etc. 

287. Potassii Chloras et Saccharum, ana. A little on 
tongue (besides steam, No. 418). Diphtheria. Acid. 
salicyl.,Bism. Subnitr. ana. To be blown into the mouth. 

288. Solutio Arg. nitr. (gr. v) f j. To be applied 
once a day. See page 111. (Besides frequent cleansing 



116 TOPICALS: 

of nose with milk or soap and water.) Ozcena. Argentum 
nitricum (3j : § j). Admovetur ter die ope penicilli 
caniellinivelprobong armata spongia durante inspiratio. 
Laryngitis {acute or chronic, ulcer or no). 

289a. Acid, carbol. 4.0; Glycerin.; Aqua 2 50.0. 
Ozcena. Kali hypermanganicum (gr.ij — v:|j,) vel 
Acidum chromicum 0.3; Aq. dest. 300.0. 

289b. Acidum carbolicum et Alcohol T 10.0; Liq. 
Ammon. 12.0; Aq. dest. 20.0. Wide mouthed bottle of 
50.0 should be filled with this to one-third, and then 
cotton q. s. to suck it up. For smelling in Catarrh. 

290. Natrum bicarbon. et Borax ^ 3 ss; Glycerin. § j; 
Aq. font. | jv. As spray into the nose. — Sol. Zinci 
chlor. (gr. ij) § j; vel Sol. Zinci sulfo-carbol. (gr. v) | j. 
vel Glycerolatum Tannini (3ij) § j. Apply with a 
cotton-wrapped probe. Catarrh. 

291. Sol. Sanguinar. cone. (min. x) to be injected into 
the substance is said to be specific in Polypus of Nose. 

292. Iodum 0.12; Pot. Iodidum 2.5; Aq. dest. 30.0. 
0.3 — 0.5, as submucous injection; vel Solutio Kalii iodati 
2 per cent. Hypertrophy of Tonsils. 

293. Tinct.Iodi § ss; Acid. carbol. 3 jss; Glycerin 3 ij. 
Once or twice a day to the thickened or ulcerated part. 
In painful deglutition of Laryngeal Tuberculosis. 

294. Pot. Chloras gr. x; Pot. Permang., Acid, salicyl. 
ana gr. v; Aqua | j. Applicatur ter die. Diphtheria. 
(In Croup, Sore Throat, and other internal inflammations 
of the throat, Acid, aceticum is sometimes applied by 
means of blotting paper, cambric or lint as blister.) 

295. Laryngotomy. In urgent cases, a penknife is 









Diseases of Air Passages, etc. 117 

passed horizontally through both skin and cryco-thyroid 
membrane at once — the latter may be felt as a soft de- 
pression an inch below the pomum Adami — after which 
the opening may be enlarged laterally to the required 
extent. 

296. Catheter in Laryngismus stridulus. Any cathe- 
ter may be employed which can be passed through the 
rima glottidis (moistened with Cocain.4 per cent)? 

297. Bougie in Stricture of Oesophagus. The patient 
sits upright, with the head thrown as far back as possi- 
ble, and the mouth wide open. A curved bougie, gently 
warmed and oiled, is passed down the pharynx, taking 
care that its point slides along the spine. To prevent 
cough by interference with the epiglottis, the patient 
should protrude the tongue as far as possible, or perform 
the act of deglutition, just when the bougie is entering 
the pharynx. (Cocain may be sometimes of service.) 

A Stomach pump is managed in the same way. Some- 
times a gag is placed in the patient's mouth (especially 
if he be insane), havingahole for the tube to pass through. 
Before beginning to pump a pint or two of water should 
be injected into the stomach, and the pumping water in 
and out should be repeated until it returns colorless. 

298a. Antiseptic Gargles. Acidum carbolicum 3j; 
Glycerin. | j; Aqua fontana § v. Scarlatina. Sol. Kali 
hypermanganici (gr. x) | v. Fetid Breath. Iodum 1.0; 
Pot. Iodid. 2.0; Aq. dest. 200.0. Salivatio mercurialis. 
Sol. Hydrargyr. bichlor. (gr. ss) § ij; Aq. Calcis § vj. 
Diphtheria. (The sublimate is used on account of its 
parasiticide properties, and the lime-water for its dis- 
solving action upon the membrane.) 



118 TOPIC ALS: 

298b. Solutio Acidi carbolici (3j: § vj) will suffice in 
mild cases of Diphtheria, without any other medication. 
It has to be used every half hour until the redness di- 
minishes, when it must be employed lukewarm, whilst 
every two or three hours Priessnitz's compress (which 
has to be warm also, when the inflammation becomes 
less) is applied to the throat: A linen handkerchief or 
rag, folded about four times and dipped in cold water, 
is put around the neck (not dripping wet) and covered 
with oiled silk or some woolen cloth, that by overlap- 
ping it on both sides will prevent evaporation. 

299. Astringent Gargles. Acidum tannicum 3j ; Spir. 
Vini Gallici § ss; Glycerin. | j; Aq. Camphorae ad \ viij. 
Relaxed Throat. Alum. 3 j; Acid. sulf. d. 3j; Dec. 
Cinchon. | vj. vel Kali chloricum 3j; Tr. Ferri chlor. 
5)ij; Glycerin. ;§ j; Aq. font. § vij. Scarlatina. 

300. Cooling and Sialogogue Gargles for Acute In- 
flammations. Acid, hydrochlor. dil. 3 ss; Glycerin. § j; 
Aq. font. | vij. Pot. Chloras, Pot. Nitras, vel Borax 3 j; 
Aq. font. | viij. Scarlatina, etc. 

301. Stimulating Gargles. Tr. Capsici 3 j — 3 ij, vel 
Tr. Pyrethri 3 iij; Aq. font. § viij. Acute Pharyngitis. 
Acid, nitricum gtt. jv; Glycerin. §j; Aq. 'font. § iij. 
As gargle or spray. Hoarseness. 

302. Acid.carbol. 3 ss; Pot. chlor. 3 ij; Glycerin. § ij; 
Aq. font. | vj. To be inhaled from a hot plate ter die. 
Pertussis* Solutio Acidi carbolici (gr. ij — 3j)|j. 
Per atomizer. Pulmonary Gangrene, Phthisis. 

*InhalatioDs of any kind should not exceed ten minutes at a 
time, and the first sittings may be from five to eight minutes. 
Moreover, they should never be performed after a full meal, and 



Diseases of Air Passages, etc. 119 

303. Solutio Tannin, (gr. ij — 3j) § j. Per atomizer. 
Chron. Catarrh, Laryngeal Ulceration, (Edema Glottidis. 

304a. .^7ther. chlor. q. vis, from a handkerchief. 
Dyspnoea (Phthisis). JEih. sulf . in Emphysema senilis. 

304b. ^Ether. p. jx; Chloroform, p. 1. An anaestheti" 
cum. Some use a mixture of Ether, Chloroform and 
Alcohol; and Ether pure to continue the anaesthesia dur- 
ing the operation. (As a rule Ether is safer than 
Chloroform; but it is contra-indicated in Kidney dis- 
eases, Pneumonia and Bronchitis. In valv. lesions either 
are contra-indicated, unless there is compensating en- 
largement. In fatty or weak heart they are also object- 
ionable, though Ether less than Chloroform. In opera- 
tions, as Kelotomy, those involving the peritoneum, and 
the removal of deep-seated tumors in the vicinity of 
large vessels, Chloroform is preferable). In any case, 
respiration, pulse and pupil should be watched, and after 
insensibility of the conjunctiva is established, its admin- 
istration should be regulated by the state of the pupils, 
i. e., the pupils should remain contracted, and only when 
they dilate, the ansestheticum should be reapplied, bear- 
ing in mind that a sudden dilatation of the contracted 
pupil during the application of Chloroform denotes 
danger. If there is fear or nervous depression, the 
administration of Chloroform should be preceded by a 
stimulant and a little morphine. 



the patient should not expose himself to the fresh air before an 
hour after the operation. No more than live to eight inspira- 
tions per minute should be made, the depth of which have to be 
regulated according to the distance of the air passages to be 
reached. 



120 TOPIC ALS: 

305. Sol. Aluminis ( 3 j) 1 ij. To be inhaled for five 
minutes from a hot plate. Haemoptysis. 

306. Solutio Ammonii chlorati (gr. ij — x) § j. Per 
atomizer. Laryngeal Catarrh. 

307. Aq. Amygdalar. amar. cone. § j. Per atomizer, 
several times a day. Cough. 

308. Amyl. aether, nitr. et Alcohol. T 2.5. Gtt. v — x 
to be inhaled from handkerchief. Angina pectoris, 
Dyspnoea, Neuralgia, Spasmus Glottidis, Epilepsy, etc. 

309. Solutio Argenti nitrici (gr. ss — x) § j. Per 
atomizer. Pharyngitis. The small dose in the follicu- 
lar and the large dose in the ulcerative form.) 

310. Liq. Pot. arsen. gtt. j — x; Aq. destillata f j 
Per atomizer. Nervous Asthma. Sometimes the fumes 
of burning writing paper, which has been imbued with 
Sol. Fowleri 1.0 (gtt. xviij) and dried, gives relief. 

311. Aq. Asae foetid. § j. Per atomizer. Asthma,etc. 

312. Extr. Bellad. 0.025: Pot. Bromidum 4.0; Liq. 
Ammon. Acet. 5.0; Aq. dest. 60.0. To be inhaled ter die 
from a hot plate until dilatation of pupil. (A two or 
three days' cure?) vel Sol. Kal. brom. 4—5 per cent. 
Gtt. xx ter die as inhalation. Pertussis. 

313. Bromum (gtt. jx), Pot. Bromidum 0.3; Aqua 
dest. 150.0. On a sponge or cotton in a tubeLof paraffine 
paper, to be placed before nose and mouth for five to 
ten minutes, and hourly repeated. Croup, Diphtheria. 

314. Camphora3j; Miher sulfuricus § ss. A few 
drops to be inhaled. Cephalalgia nervosa. 



4 
Diseases of Air Passages, etc. 121 

315. ^ Extr. Cannab. fl. gtt. j — jv, vel Tr. gtt. x — xx; 
Aq. dest. 5J. Per atomiser. Irritating Cough. 

316. -IJ Chloroform, part, v; 01. Terebinth, pars j. 
Anaesthetic. (01. Terebinth, is said to prevent (Edema. 
Antidote : Pulv. aerophor. As an Emetic. Amyl or Am- 
monia to smell at.) Chloroform, gtt. iij — jv at the time. 
Trismus nascentium. See No. 304. 

317. ^ Sod. chlor. gr. v — x; Aq. font. 3J. Per ato- 
mizer. Expectorant. Liq. Sod. chlor. 3ss — j; Aq. font. §j. 
Phthisis. (If breath or expectoration offensive.) 

318. ^ Cocain. gr. viij; Pot. chlor., Aq. Amygdal. 
am. a 3j; Aq. dest. 3 viij. From a hot plate bis die for a 
few miuutes. Pertussis. 

319. t> Extr. Conii fl. gtt. v — xv; Aq. font. |j. Per 
atomizer. Cough [Phthisis). Vel: Extr. Hyoscyam. 
fl. gtt. v — x\; vel Morph. sulf. gr. -§-. 

320. ]J Tr. Ferri chlor. 3j, vel Liq. Ferri sub- 
sulf. 3ss ; Aq. font, f j. Per atomizer. Hozmoptysis. 

321a. 5 Tr. Iodi, Chloroform, a 10.0; Acid, carbol. 
gtt. xv. Gtt. v from a glass tube placed in hot water 
to be inhaled bis die by the nose. Nasal Catarrh. (A 
one day's cold cure?) 

321b. r> Sol. Pot. iod. (gr. ij — xx) 3J. Per atomizer. 
Emphysema., Chron. Bronchitis. 

322. 5, 01. Junip. Bacc. 3ss. To be dropped on a 
sponge dipped in hot water and squeezed for inhalation 
ter die. Dropsy. (Where the state of the stomach pre- 
cludes the internal use of diuretics.) 

323. ]J Inf. Picis. liq. |j. Per atomizer. Gangrene. 



122 TOPICALS: 

324. ^ 01. Terebinth, gtt. ij; Magn. carb. q. s.; 
Aq. font. f j. Per atomizer. Bronchitis, Emphysema. Vel : 
Ol. Terebinth, q. v.; Aq. bulliente q. 1. Gangrene. 

325. 5- Sol. Sod. nitr. (10. o) 40.0. Liquore plagulae 
quatuor ad quinque chartse bibulse imbuantur et calore 
non adhibito siccentur. Asthma. (\ sheet to be burnt 
at the time.) 



DISEASES OF MALE GENITALS, ETC. 

326. ^ Bism. nitr. 15.0; Aq. dest. 200.0. Injiciatur 
ter die.* Gonorrhoea {secundaria.} 

327. ^ Acid, carbol. 3j; Glycerin. §ss; Aq. font. |vj. 
As injection in Gonorrhoea; as lotion in Chancroid. Sol. 
Acid, carbol. (gtt. j) 3j; Alcohol, gtt. ij. Gtt. x — xx as 
injection in Bubo. (It must be injected deep into the 
bubo, and pain and inflammation will rapidly subside?) 

328. 3 Sol. Acid, chrom. (0.3) 300.0. Injection. 
Gonorrhoea. 

329. Ijfc Calomel. 3j; Aq. Calcis |vj. Blackwash 
Chancroid. (If the chancroid be under six days old, 
Nitr. acid is preferable ; but this has to be done care- 
fully, with a pointed stick — like a match, for instance.) 

330. 5- Sol. Cocain. 4$ gtt. x; Aq. dest. 3ss. To 
be injected. Chordee. A solution of this strength is suf- 
ficient to render the introduction of a catheter painless ; 

*The injections must be made after urination, and may 
be done as often as 4 times a day, each time keeping the 
liquid in contact with the sore for about one minute, by 
holding the penis upwards. 



Diseases of Male Genitals, etc. 123 

and a 4 per cent, solution, undiluted, is very valuable in 
cauterization and excision of Condylomata. In operating 
on Stricture, 3^s may be injected in three doses, at inter- 
vals of ten minutes, each time to be retained a little. 
Then the urethrotome may be introduced, and the canal 
cut to No. 40 of French scale if necesssary (from 3^ 
inches back of meatus to corona).* 

In Phimosis, as hypodermic injection of 12m. at the 
dorsal base of the penis, and after 15 minutes 5m. more if 
necessary. The operation may be commenced as soon 
as the penis has turned dumb, cold and blue, using a 
clamp. Hemorrhage will be but little, as the haemostatic 
action of Cocain is very marked. (Or the solution may 
be painted over the external surface of the foreskin and 
over the mucus membrane several times within half an 
hour, by means of a camel's hair brush.) See No. 263. 

331. 5 Sol. Fern et Pot. tart. (20.0 — 30.0) 200.0. 
As lotion. Phaged. Chancre. Vel : Iodol, see No. 269. 

332. 5 Tr. Iodi, Aq. dest. a 3j — 3ij. Injection. 
Hydrocele. The tumor is grasped from behind and a 
trocar passed into it, taking care to point the instrument 
after penetration upwards, to prevent wounding of the 
testicle. Now the canula is pushed well into the sac, to 
allow the fluid to escape. This dose is injected by means 
of a glass syringe, the nozzle of which is made to fit the 
canula. 

* Aspiration of the Bladder in Stricture from ure- 
thral or prostatic disease. The puncture of the bladder 
must be made at the most prominent and tense part of 
the tumor, and exactly in the median line. (Once or 
twice a day until the urethral passage is re-established.) 



i2 4 TOPICALS: 

333. 3 Tr. Opii 3j; Pot. brom. 3j; Glycerin. |ss; 
Aq. font. §ijss. Four injections daily. Gonorrhoea. Vel: 
Liq. Ferri dialysati |ss; Aq. dest. |ss — §j. Vel: Extr. 
Hydrast. fl. 3ij ; Aq. font. §jv. Injiciatur bis die. 

334. 5 Sol. Pot. permang. (gr. x) |v. Gonorrhoea. 
If chronic, gr. v — x : |j. The same strength may be used 
in suppurating Bubo, after having drawn off the contents 
with an aspirator, if it be still intact. See page 82. 

335. Ijfc Sol. Resorcin. 5 per cent. Two to three in- 
jections. Cystitis. If chronic, 5 — 10 per cent. (397.) 

336. ^ Sol. Zinci chlor. (0.2 — 0.4) 100.0. As injection. 
Gonorrhoea. Vel : Sol. Zinci sulfo-carbol. (gr. xv) §viij. 
Vel: Liq. Plumbi 3j ; Zinci sulf. gr. x; Aq. font. Iviij. 
Vel : Liq. Plumbi, Spir. V. Gall, a 3j; Aq. dest. fviij. 
Vel: Zinci sulf. 0.2 ; Alumin. 1.0; Aq. dest. 100. o, turn 
adde Sol. Tannini (1.0) 100.0. 



DISEASES OF FEMALE GENITALS, 
THE WOMB, ETC. 

337. 5 Sol. Acid, carbol. (3j) Oj. As wash in Pru- 
ritus Vulvae. Vel: Sol. Zinci sulfo-carbol. (3j) lij. Vel: 
Infus. Tabacci. Vel: (Acid, carbol. 3j), Plumbi acet. 3j; 
Tr. Opii f ij ; Aq. font, ad Oj. Lead and opium wash. 
Dossils of lint soaked in it and placed in the vulva. 
Vulvitis. 

338. 5- Sol. Zinci sulf. (3ss) §v. As wash. Leucor- 
rhoea of children. (The vulva has to be bathed twice a 
day, after having washed it with soap and water.) 



Diseases of Female Genitals, etc. 125 

339. g, Hydr. bichlor. 3ss.; Tr. Opii |j; Aq. 
font. 3 vij. To be applied bis die. Pruritus Vitlvce. 
Camph. 3 j; Amyli 3 v. Apply once a day. Pr.pudendi. 

340. IJ Acid, tannic. 3ss; Bism. nitr. 3j; Opii 
gr. x. To be dusted over the sore. Chancroid. Vel. Pot. 
permang (334). Cupri acet. v. Alum, usti, Sabin. p. a 3j. 
To be dusted over the excrescences once a day. Condylo- 
mata, Vaginitis from warts. 

341. 5- Alum. p. q. v. In a linen bag placed in con- 
tact with the Cervix, and held in place by a tampon (369). 
Metrorrhagia {Cancer). Vel. Tannin 3 ij, applied dry. 



Catheter in Retention of Urine. — The instru- 
ment is to be introduced in an oblique direction from 
without inward in the urethra of a healthy, unimpregnated 
woman; but in certain diseases, or the latter stage of preg- 
nancy the other extremity of the catheter must be 
depressed as soon as it enters the meatus, the urethra, on 
account of the ascent of the uterus having become nearly 
perpendicular, so as to pass along the internal surface of 
the sy7nph. pubis. In case of retention of urine, when 
arising from undue pressure against the neck of the blad- 
der by the gravid uterus, where in spite of the removal of 
this pressure by the elbow and knee position, the urine 
can not be voided, the catheter will enter with more 
facility than in any other position. 

In every case % of disease, with or without hemorrhage ■ 
unless the cause be palpable, it is advisable to examine 
systematically the entire uterus and its surrounding tis- 
sues in the following manner : 1. The cervix should be 



126 TOPICALS: 

342. 5. Sod. chlor. p. j; Aq. frigore concret. p. ij. 
In a linen bag, to be carried up to the ulcerated surface 
by means of a speculum. Carcinoma. (After removal 
the pain begins again.) 

343. ^ Sol. Arg. nitr. (gr. x) §j. To be applied 
every other day. Vulvitis follicul. et purulent a, y 2 dr. to 
1 oz. in Endometritis. 1 dr. to t oz. applied to vagina by 
means of a sponge-probang, after having cleansed it, 
once a week. Leucorrhcea. (Afterwards a Glycerine- 
tampon [369] for 24 hours.) Arg. nitr. in baculo, applied 
to erosions, ulcerations, etc., of the Os about once a week, 
is the best and most simple procedure; every application 
should, however, be followed by the salt-wash (261), and 
it should be, moreover, covered by a Carbol-tampon, 
saturated in Glycerine (369), or it may be protected by a 
coating of stypt. Collod. (415). 

investigated by touch, the speculum and the uterine 
probe. 2. The uterus and the whole pelvis should be ex- 
amined by conjoined manipulation, palpation and rectal 
touch. 3. The cervix should be dilated by tents, and the 
cavity of the body explored by the introduction of the 
index finger, by the sound and the curette. (It will re- 
quire generally three and even four tents to open the 
cavity of the body fully to the finger.) 

The examination may be made on a table, covered 
with a blanket, shawl, or rug of some kind, and provided 
with a small pillow. Should it be necessary to employ 
a bed, the leaf of a dining table or a wide board may be 
slipped across the mattress, under the upper sheet and 
covering, so as to get a hard surface to lie upon. 



Diseases of Female Genitals, etc. 127 

344. ^ Sol. Acid, chrom. (3j) |j. Endometritis. 
y 2 oz. to 1 oz. to destroy the glands of the cervical canal. 
Cystic Degeneration. Vel : Hydr. nitr. acid, vel Sol. Zinci 
chlor. (3j) 3J. 

345. 5 Liq* Ferri persulf. 3j ; Glycerin. |j. To be 
applied twice a day (besides dusting with Amylum, Bism. 
or Lycopod.) Vulvitis follicuL et pwulenta. 

346. 5 Plumb, acet. 3] ; Acid, hydrocyan. dil. 3ij; 
Cacao §j. Apply after having washed the part with cold 
water. Vulvitis (if Pruritus). Borac. v. Plumb, acet. 3ij ; 
Glycerin. |j, by means of vaginal tampon (369). 

347. 5 Hydr. bichlor. gr. ij ; Aq. Calcis |j. Con- 
dylomata. Vel : Cupr. sulf. in baculo. To be applied 
every five or six days — Cupr. sulf. p. x ; Borac. p ij ; 
Pulvis subtilissimus c. Aq. font, fiat massa ex qua 
formatur bacillae. 



In a first examination the patient should always lie 
upon her back, with the buttocks very near the edge of 
the board, the clothing loose around the waist, and the 
knees drawn up to relax the abdominal walls. When 
small tumors exist behind and disconnected with the uterus,. 
or where enlarged or prolapsed ovaries are to be sought 
for, or in case Sim's speculum or one of its modifications 
should be necessary, the patient should be placed in 
Sim's position, that is, on the left side, in such a way 
that breast and stomach are inclined towards the plane of 
the table. The left arm must be drawn behind the patient, 
so as to let her rest on the left side of the chest, and the 
right leg be so flexed as to let the right knee lie just above 



128 TOPICALS: 

348. fy Tr. Iodi, Glycerin, a 3ij. Granular Degen- 
eration, Vel: Tr. Ferri chlor. 3ij ; Aq. font. §j. To be 
applied once or twiceja week. Iodoform, gr. xv; Pot. iod., 
Glycerin, a 3ij ; Alcohol 3vj. Twice a week to cervix. 
Cervical Hyperplasia. 

349. ^ Zinc, chlor., Aq. dest. a q. s. To touch the 
affected part once a day ; and every 3 hours a douche to 
the vagina. Afterwards an occlusion-pad (371). Puer- 
peral Diphtheria. (A suppository of Iodoform [374] in 
rectum will be of service; and, if the uterus be affected, 
a warm intra-uterine injection of Sublim. [397] must be 
made.) 

350. ^ Ungt. Atrop. (gr. ij) |j. To be applied 
to the vaginal wall in Congest, and Nerv. Dysmenorrhcea, 
Vaginismus, etc. Vel : Ungt. Bellad. (3j) ij, vel Ungt. 
Hyoscyami, Opii, Stramonii, etc. Ungt. Atrop. is also 
valuable in Pruritus Vulva. 

the left — the lower trochanter must be by two or three inches 
nearer the examiner than the upper, or the use of a speculum 
will not be successful. 

Speculum, With the exception of Thomas' telescopic 
speculum, cylindrical instruments render, on account of 
their length, probing through them, or an examination by 
touch, quite impossible; as in anteversion it is as difficult 
to get the cervix into the field, as it is to carry applica- 
tions to the fundus. It will be best in most cases to 
employ Sim's speculum, (if there can be had an assistant) 
or, what may be still better, a modification of the latter. 
If a cylindrical or valvular speculum is used, the patient 
lies on her back, whilst the physician sits on a chair. 



Diseases of Female Genitals ^ etc. 129 

351. ]J Bism. nitr. 3j ; Acid, oleic. |j. Solve leni 
calore, turn adde Ungt. Petrol. 3J. To be applied on 
cotton. Ulceration of Os. Vel : Iodof. 3 j ; Acid, oleic. |j. 

352. 5 Ungt. Creosoti |j. Applicat. mane nocteque. 
Pruritus vulvce. Vel : Ungt. Chloroform, vel Chloro- 
form. 3j; 01. Amygdal. §j. 

353. 3 Ungt. mercurial., Cerae flavae, Adip. suilli, 
a 3SS. To lubricate the os uteri bis die, whilst the 
abdomen is rubbed once a day with the following: 
Iodi gr. v ; Pot. iod. 3j ; Ungt. mercurial. 3SS; Axung. 
Porci 3J. To check the growth of Fibrous Tumors, 
Ungt. Calomel. (3j) 3J. Condylomata. 

354. IJ Iodof. 3ss ;. Cacao 3J. To be introduced 
Into the womb by means of an applicator. Fndometritis . 
Vel : Cacao in Subinvolution, (The applicator — a silver 
tube of 4- inch diameter, and 8 inches long — is filled by 
forcing it into the mass for about 2% inches, and then 
discharged into the uterus.) 

355. 5 Acid, salicyl., Ungt. Petrol, a 3SS. On a sponge- 
tent of one inch, to be introduced into the cervical canal — 
to remain for 12 hours — twice a week. Cerv. Endometritis, 

The finger, having been thoroughly lubricated with soap, 
is now passed into the vagina to ascertain the position of 
the cervix, after which the speculum may be well oiled 
and gently inserted. 

2he Sound. While the patient lies on her back, the 
position of the uterus, resp. the direction of the cer- 
vical canal must be ascertained by passing the finger first 
into the fornix vaginas, over its posterior surface, and 
then along]^the base \oi ^the bladder, over its anterior 



130 TOPIC 'A LS: 

356. 5 Extr. Bellad. gr. j; Sapon. gr. iv; Cacao 3ss. 
As suppository at night. Vaginismus, Vel: Iodof. 1.0, 
Cacao 25.0. Anoayne. Vel: Extr. Bellad. gr, v ; Acid, 
tannic. 3 i j ; Cacao |j. Suppositoria 20. One at night. 
Pruritus Vulva. 

357. ^ Zinc. oxyd. gr. iij; (Extr. Opii v. Bellad. gr. j); 
Cacao 3ss. As vaginal suppository, once or twice a day. 
Granular degeneration. (Instead of Zinc may be used 
Alum gr. iij, Plumb, acet.gr. v, Tannin gr. ij, Ungt. mer- 
curial, gr. x, etc.) 

358. ^ Tr. Opii §j; Glycerin, fij; Aq. calid. Cij. 
Emollient vaginal injection, to be used daily for 20 to 30 
minutes. Vaginitis, Hyperplasia. Other emollient injec- 
tions are: Dec. Amyli; Dec. Hordei; Dec. Ulmi; Inf. 
Conii; Inf. Humuli ; Inf. Hyoscyami ; Inf. Lini ; Aq. 
Calcis ; Aq. Picis, etc. (In Subinvolution, 1 y 2 gall, hot 
water — 120 to 125 — against the cervix, will stimulate 
and thus produce absorption of the redundant tissue.) 



wall. The speculum is then introduced, the patient 
retaining the dorsal decubitus, if a- short cylindrical instru- 
ment be employed; and being turned on the left side 
if Sim's or one of its varieties be used. As the probe 
will only pass if it has been properly curved, it must 
be bent again and again, until the direction of the canal 
is fully discovered (sometimes the inflection given to the 
sound must be the arc of a small circle; sometimes a 
sharp angle; sometimes even a spiral twist is required). 
Tents. As a general rule, laminaria (sea-tangle) tents 
are preferable to sponge tents, as they do not become 



Diseases of Female Genitals, etc. 131 

359. 5 Zinc. sulf. 3j; Glycerin, fj; (Tr. Opii lss-j;) 
Dec. Hordei v. Aq. calid. Cj. Astringent injection, to 
be used daily for 10 to 20 min. Granular Degeneration^ 
Pruritus Vagina. (Zinc. sulf. may be replaced by 2 dr. 
of Alum, Plumb., or Tannin.) 

360. 5 Acid, tannic. §j; Glycerin. 31V. ^ oz. to 
1 litre of tepid water morning and night. Leucorrhoea. 
Vel : Liq. Ferri dialysati p. ij, Aq. font. p. j. Tannin. 3ss; 
Morph. gr. ij ; Glycerin. I'w. On cotton (369) after 
having painted the vagina with Arg. nitr. (343). Vaginitis. 

361. IJ Ferri sulf. 3j; Dec. Quercus Oj. 2 oz. to be 
injected bis die. Prolapsus Vagince. (The iron may be 
replaced by Alum, et Zinc, a 3j.) In Gonorrhoea Mangan 
(334), or Phenol (327), or 1 dr. of Alum or Zinc to one 
quart of water daily. 

362. IJ Acid. nitr. d. 3j; Aq. font. Oj. in mucous and 
muco-purulent discharges of Carcinoi7ia. 

putrid like the latter, and may therefore be retained for 
24 hours and more. 

They may be medicated with Morph., Iod. or anything 
soluble in water (they do not absorb alcoholic solutions 
or Glycerine), and then dried again to be kept for use. 
It will be, however, advisable to steep them before use 
in a solution of Carbolic acid or some other antiseptic. 
Though they rarely produce any pain or irritation if just 
before introduction placed for a few minutes in warm 
water to soften them, it is better to insert several small 
tents than one large one, as the small ones expand more 
rapidly than a large one. 

If the uterus be low in the pelvis and its neck dilated, 



132 TOPICALS: 

363. 3 Sol. Alum. (gr. xij) |iij. Cauliflower [serous 
discharge). Vel: Liq. Ferri perchlor. 3ij ; Aq. font. |ij. 
vel Inf. Matico; vel Tannin. If feior: Sol. Calc. chlor. 
(3ij) Oj. vel Dec. Carotae. vel Creosoti 3j; Dec. Lini Oj. 

364. Sol. Arg. nitr. (3j) |iv. One syringeful every 2 
or 3 days. Urethritis. 

365. ^ Tn Opii 3ss; Aq. tepid. |jss. Carcinoma (if 
pain), vel Chloral. 3ss; Aq. font. §ss. To inject at night, 
Vaginismus. Vel : Pot. brom., Chloral, a gr. xv; Aq. font. 
|ss. On cotton, by speculum. (It has to be retained by 
a tampon of dry cotton, with a thread for removal — 369.) 
JVeura/g. or Congest. Dysmenorrhea, partial closure of Os. 

a tent may be held in the bite of any pair of uterine 
dressing forceps and slipped in without the speculum, 
the woman lying on her back. In ordinary cases they 
may be introduced through the short cylindrical specu- 
lum, though in all cases it is most easily done with Sim's: 
The uterus being fixed and held by a tenaculum, the 
tent, grasped by a pair of mouse-tooth forceps, is directed 
in coincidence with the axis of the uterus, as ascertained 
by the probe, and gently pushed through the cervix. 

The patient has then to remain in bed until its 
removal, which is done after from 12 to 24 hours by 
traction upon the thread attached to it (the cord should 
always be fastened at the upper extremity of the tent 
and passed through it). 

As this mode of diagnosis and treatment is more or 
less dangerous, the following rules should be observed: 
1, No force whatever should be employed, and, should 
the tent not pass the os internum, it either should be bent 
so as to follow more^accurately the cervical canal Jas 



Diseases of Female Genitals, etc* 133 

2,66. ^ Liq. Ferri perchlor. |ss; Aq. font. §ij. 2 syringe- 
fuls, and, if necessary, to be repeated. Carcinoma (if 
Hemorrhage}. Vel: Liq. Ferri persulf. p. j; Aq. font, 
part, iv, with a tampon, which fills the vagina (by spec- 
ulum) ; vel Sol. Zinci sulf. (3j) fxij, as injection. 

367. Sol. Ferri persulf. p. j ; Aq. font. p. ij. Vel: Tr. 
Iodi for injections of the uterus, after dilatation of cervical 
canal. In serious cases of Metrorrhagia. 

368. Acid, carbol., Alcohol, a |j to a quart of hot 
water as injection of the uterus. Flooding from Abortion. 

369. Carbol-Tamfion and Pessary: A wad of absorb- 
ent cotton — prepared of fine cotton having been im- 
mersed for about 3 days in a cone. sol. of Bicarb, of Soda, 
squeezed and washed repeatedly in clean water, and dried 
in the sun — is dipped in Sol. Acid, carbol (gr. x) f xij, 
and may now be used, saturated in Glycerine or medicated. 
(It acts at the same time as local hydragogue, disgorging 
the tissues.) Uterine Displacements, Granular Degenera- 
tion, Vulvitis, etc., — most valuable after the application of 
Caustics to cervix and vagina. 

ascertained by the probe, or exchanged for a smaller one. 
2, It should on no account be introduced at the physi- 
cian's office, as the patient has to be confined at once to 
the recumbent position. 3, A tent should never be used 
where there has been chronic pelvic peritonitis. 4, It should 
not be allowed to remain in the uterus more than 24 hours, 
when the vagina should be washed out with an antiseptic 
lotion, and, if any pain, chilliness or discomfort follow, 
Opium should be given freely and perfect rest enjoined. 
5, The patient should remain in bed for at least 24 hours 
longer, even if there be no pain, etc. 



i 3 4 TOPIC ALS: 

370. Tampon in Hemorrhage from Abortion, etc., a 
piece of cloth or lint of about 6x6 inches, dry or soaked 
in Glycerine, is centrally to be placed over a finger or 
catheter, and thus introduced into the cervical canal. 
Then the finger having been retracted, the points of the 
four corners of the linen must be pushed likewise into the 
canal. This procedure has to be repeated with one or 
two pieces more until the desired object is obtained. 

371. Occlusion- Pad for lying-in-women. Absorbent 
cotton wet with Sol. Hydr. bichlor. (gr. ij) §viij is placed 
over the vulva and covered with oiled silk; on this is put 
another layer of absorbent cotton, and a piece of muslin 
to be attached to binder. Prevention of Diphtheria. 



DISEASES OF THE RECTUM, ETC. 



372. Acid, carbol., 01. Olivar. a §ss; Iodof. vel 
Morph., vel Chloral, q. v. As injection into the substance. 
Hczmorrhoides. Or the surface of the protruded piles be- 
ing wiped with lint, a portion of it, (the size of a 5-cent- 
piece,) is dapped with a wooden stick dipped in cone. 
Nitric or Carbol. acid. When this has taken effect, any 
superfluous acid is to be mopped up, some ointment or 
grease applied, and the parts returned. The patient 
should keep in bed and the bowels not disturbed for 48 
hours. When the slough caused by the acid separates, 
the surface generally cicatrizes speedily, and leaves the 
part brazed up and healthy. 



Diseases of the Rectum, etc* 135 

373. Extr. Hyoscyami 1.0; Extr. Opii 0.5; Aq. 
font. 5.0. Solve, turn admisce Glycerolat. simpl. 60.0. 
Applicatur bis die. Piles. Vel: Iodof., Bals. peruv. a 
1.0; Ungt. Petrol. 4.0. Zinc. oyxd. 5.0; Glycerolati 
simpl. 25.0. Fissura Ani, etc. 

374. Iodof. gr. xv; Cacao gr. x. F. supposit. Diph- 
theria puerperal. Iodof. 3ss; Cacao 3jss. Div. in 6 sup- 
positoria. One every night, alternately in vagina and rec- 
tum. Uterine Excitement j Ovarian Dysincnorrhoea. Vel: 
Iodof. 2.5; Cacao 40.0. F. 10 supposit (354 and 356). 

375. Extr. Bellad. gr. ss; Opii gr. j — iij; Cacao 3j. F. 
supposit. Oxaluria (if pain). Vel: Extr. Conii gr. ij; 
Extr. Hyoscyami gr. iij; Cacao 3j. Vel: Extr. Bellad. gr. j; 
Opii gr. iij; Asae foet. 3ss; Cacao 3jss. F. 6 supposit. 
Uterine Irritation; Dysmenorrhcea membr. Vel: Extr. 
Bellad., Morph. a gr. ij; Cacao 3ij. F. 6 supposit. One 
every 4 hours until pain subsides. Abortion. 

376. Ungt. Hydr. nitr. gr. ij; Cacao 3ss. F. 6 supposit. 
One at night. Oxyuris. Vel: Inf. Absynth. v. Quassiae 
fij. As enema. Trichocephalus. Vel: Sol. Acid, carbol. 
(3j) |ij; v. Acet. Vini as injection.* 



Enemata. Independent of their employment in womb 
and rectal diseases, they are of much use in hastening 
the action of Cathartics, taken by mouth, or in the removal 
of feculent accumulations in the rectum. They relieve, 
moreover, frequently tympanitis, and for the purpose of 
revulsion they are most valuable, to say nothing of their 
value in alimentation in cases of irritable stomach. 



136 TOPICALS: 

377. Tr. Ferri chlor. 3ij; Aq. Calcis §jv. Half the 
dose each time for 2 consecutive nights to be injected and 
followed the next day by a Cathartic. Ascarides. Vel: 
Syr. Allii, 01. Terebinth, a |ss; Inf. Lini §vj. As enema. 

378. Tr. Kino, Tr. Catechu a 3ss; Tr. Hyoscyami 3j; 
Aq. font. |ij. 3j — ij to be injected twice a day, after hav- 
ing returned the part by pressure with an oiled sponge. 
Prolapsus Ani. Vel: Tr. Ferri chlor. 3ss; Inf. Quass. §viij. 
Also of use in Invagination of rectum. 

379. Chloral, gr. iij — viij; Muc. Acac. 3j. As enema. 
Infantile Convulsions. Urcemic Coma. Vel: Acet. Vini, 
Aq. font, a |ss, as revulsive; vel 01. Olivar., Aq. tepid, a §ss, 
to maintain a soluble state of the bowels after having 
given a purgative. Convulsions from teething. 

380. Spir. Vini Gall. 3SS; Inf. Theae |ij. To be in- 
jected every half hour. Asiat. Cholera. Sp. Vini G. 3j; 
Aq. font. |ss. As enema during the fit. laryngism. striduL 

381. Tr. Opii 3ss — ij; Sol. Amyli 3I1J. To be injected 
directly after evacuation and repeated once or twice if it 
be quickly rejected. Dysentery \ Sporadic Cholera. Tr. 
Opii, Tr. Asae foet. a 3j; Dec. Amyli fiij. As enema and 
to be repeated after one hour if necessary. Colic. Tr. 
Opii gtt x; Tr. Bellad. gtt xx; Tr. Asae foet. 3ij; Aq. 
tepid. I iij. As enema to be retained. Me?nbr. Dystnenorrh. 
Tr. Opii gtt xx vel Tr. Hyoscyami 3j; Aq. tepid. §iij. 
As enema every night until quickening. To prevent 
Abortion. 

382. Sol. Acid, carbol. (0.15 — 0.2) 150.0. As enema. 
Diarrhoea and Rectal Diseases (children 0.05: 120.0). 



Diseases of the Rectum, etc. 137 

383. Ext. Ergotse fl. 3 ij; Aq. font. | ij. As enema. 
Ulcus stomachale. 

384. Sol. Chinini bisulfurici v. Chin, hydrachlor. 
amorph. as enema. Intermittens, etc. See page 11. 

385. 01. Ricini § iij; (01. Tiglii gtt. jv;) Kali carb 
gr. xv; Sapo3j; Aq. fervida Oj. Apoplexy. 01. Tere 
binth. | j; Muc. Acac. § ij; Dec. Hordei Oj. Insolatio 
01. Terebinth. 12.0; Camphora 1.5; 01. Olivar. 60.0 
Vitellum Ovi 1 ; Dec. Hordei 300.0. For 2 or 3 enemata, 
Tympanitis. Syr. commun, vulgo Molasse, 01. Olivar 
"a | ij; Sapo. q. 1.; Aq. tepida Oj; vel Sol. Sod. Chlor, 
( 3 ij) 3 jv. As derivative. Scarlatina. 

386. Aq. fervida f viij — Infusum Sennae ( § ss) Oj. 
vel Sol. Magn. sulf. ( § ij) Oj. Purgative. 

387. Pepton. p. j; Aqua fervida p. ij. As enema. 
Scraped meat 5 oz. ; finely chopped pancreas l£ oz.; 
water 3 oz. Nutrient enemata may be composed of 
very strongbeef or mutton broth,(not to exceed 4 ounces) 
without salt or spice. They should be preceded by 
a large enema to clean the bowels; and if the rectum 
will not retain them a little Laudanum may be added. 



SKIN DISEASES, ETC. 

388. Ferrum sulf. 0.4; Natrium chlor. 10.0; Aqua 
100.0. vel Fol. Jaborandi 20.0; Aq. Coloniensis 200.0; 
Macera. Hairwash. Ammon. carb. 3j; Borax 3ij; 
Glycerin. | ss; Aqua |jv; Spir. Myrist. Oj. Shampoo. 
Sod. sulfuret. 3.0; Calc. usta et Amylum ? 10.0. Mixed 
with water to apply to the part. Depilatorius. 



138 TOPICALS: 

389. Oleum Ricini §j; Spir. Vini Gallici § vij. 
Diseased Hair-roots. Bals. peruv. 20.0; 01. Ricini 50.0. 
To apply to scalp. As dressing iuPanaritiumtwice a day. 

390. Naphthol 5.0, Bals. peruvianum 2.5, Alcohol & 
Glycerin,'? 20.0; 01. Bergamott 1.0. To apply bis die. 
Pityriasis, Lichen, Scabies, etc. Borax 1.5; Glycerin 
30.0; Aq. Rosar. 100.0; Aq. Coloniensis 20.0; Tr. 
Quillajse 50.0. Pityriasis. Stinking Sweat. Sol.Boracis 
( | j) Oj; vel Sol. Kali carb. ( § ss) Oj if much itching: 
To wash the head in the morning, having oiled it the 
night before. Ungt. Calomel ( 3 j : § j) if Alopecia. Borax 
10.0; Kali carb. & chlor. ? 5.0; Aq. Aurant. flor., Aq. 
Rosar. ? 75,0; Glycerin 30.0. Moles, Freckles, etc. 

391. Cuprum oleatum 3 i j ; Lanolin § j. To apply 
bis die. Tinea favus. Ungt. Zinci |j. After having 
detached the scab by moistening it with a Solution of 
Sod. Carb. ( 3 j: 1 j) and the application of a bread and 
milk poultice. Crusta lactea. 

392. Bism. nitr. prsec, Hydr. prsecip. album'? 5.0; 
Glycerol. Amyli 20.0. Cosmetique blanc. Kal. iod. 5.0; 
Natr. bicarb. 1.0; Aq. font. 400.0. Pimples. 

393. Bism. nitr. pr., Zinc. oxyd. ? 2.5; Glycerol, 
simplex 30.0. Intertrigo. Zinc, tannic. 10.0; Glycerol, 
simplex 30.0. Tinctura Benzoes 2.0. vel Alcohol and 
Albumen. Decubitus. 

394. Sod. Boro-salicyl. 20.0; Aqua font. 100.0; Spir. 
Lavandul. comp. 50.0. vel Borax 3 ij; Chloral 3 ss; Aq. 
fl. Aurant. & Rosar. ? | iij. Pruritus, Urticaria, etc. 
Glycerin |j; Aq. Coloniensis § v. vel Unguentum 
Petrolei. Pruritus from Scarlatina.. 



Skin Diseases, etc. 139 

395. Acid, salicyl. 3.0; Amylum 10.0; Talcum 87.0. 
F. pulvis anthydroticus; vel Acidum nitricum gtt. x Aq. 
font. Oj, as wash. Sweating feet. 

396. Plumb, aceticum 25.0 — 50.0; Alum. 12.5 — 25.0. 
Aq. dest. 500.0. With lint as dressing to foul ulcers. 
Resorcin 2.5; Glycerin 10.0; Tr. Benzoes comp. 40.0; 
Aqua 100.0; vel Resorcin & Ungt. Petrolei ana, as 
dressing for poisoned wounds, accompanied by inflamma- 
tion of Lymphatics. 

397. Hydrarg. bichlorat. 1.0; Acid, hydrochlor. 2.0; 
Aq. destill. 10.0; vel Sublimate 1.0; Natr. chlor. & Acid, 
acet. ^ 0.5; Aq. dest. 10.0. Each for 1000.0 of warm 
water as disinfecting wash for hands, etc. For irriga- 
tion of wounds a solution of 1 :2000 will be sufficient; 
and for internal organs, e. g., the uterus, it should not be 
stronger than 1:5000. * 

* Antiseptic Wound Treatment. — After having thoroughly 
cleansed the wound with warm boro-salicylated water (399) 
and dried it with absorbent cotton, the edges of the cut are 
brought in apposition and retained there by means of plaster, 
with or without catgut sutures, care being taken to avoid ten- 
sion; as it is better to have the wound gaping than its edges 
dragged by sutures, especially if the tissue is damaged or un- 
healthy. Now it is dressed with three layers of antiseptic 
gauze (416a) saturated with boro-glyceride and covered by a few 
gamgee pads (absorbent cotton covered with antiseptic gauze), 
which are held in place by means of a gauze bandage. If there 
be much laceration and bleeding, the vessels must be picked up 
with forceps and tied with catgut. Then having placed in the 
wound a drainage tube, or if it be small, a few strands of catgut 
(which are absorbed in due time), the edges may be brought 
together with silk sutures, if practicable, and the following 
dressing applied: The wound being moderately dusted with 
iodoform, is covered with gauze — provided with holes for the 
tubes — likewise dusted with iodoform, after having been wrung 
out of sublimate water (297), over which are placed a few gamgee 
pads. The whole to be retained by means of a gauze bandage. 

Nussbaum prefers in all cases, where there is a possibility of 



140 TOPICALS: 

398. Acid, carbol. 10.0; Aqua 300.0; Brom. 5.0. 
Dissecting wounds. Acid, carbol. & Alcohol Tl. 0; 
Glycerol, spl. 50.0. Ulcers. Acid, carbol. 0.5; Zinc, 
oxyd. 1.0; Liq. Plumbi & Tr. Arnicae 2 gtt. x; Ungt. 
Petrol. 15.0. Eczema, Herpes, etc. Acid, carbol. 4.0; 
Ungt. Petrolei 50.0. To apply twice a week. Sycosis, 
Lupus, etc. Creosot 5.0; Alcohol. 10.0; Glycerin 85.0. 
Erysipelas. Phenol. 1.0; 01. Olivar. 40.0. Carbolic Oil. 

399. Acid, salicyl. 1.0; Alcohol. 2.0. (Tr. Benzoes 
1.0); Lanolin. 4.0; vel Pix liq. 10.0; Glycerol. spl. 30.0; 
vel Bism. nitr. cryst. 5.0; Aqua & Glycerin. ^ 2.5; turn 
adde Glycerin ad 100.0. Herpes facialis, Ulcers, etc. 
Acid, salicyl. 2.0; Acid, boric. 12.0; Aq. calida 1000.0. 
Wash for simple cuts, etc. 

400. Extr. Opii, Extr. Bellad., Glycerin IT 3j; Ungt. 
Resinae § j. Boils. Acid, arsen. gr. ij; Ungt. Petrol. § ]. 
Onychia maligna. Calomel, gr. jv; Aq. Calcis | j. The 

ploughing, carbolized gauze moistened with phenol water 
2^:100, or a 20 per cent, iodoform gauze, soaked in a solution 
of boric acid, covered with a few layers of dry gauze and 
salicylated wadding, which he keeps in place by means of an 
impermeable bandage. Two points ought to be borne in mind: 
1. The wound must be redressed in order to remove the drain- 
age tubes, which has to be done in a day or two, according to 
the discharge; or if there is much pain or hemorrhage; though 
the dressing need not be changed because serum has oozed 
through it — antiseptic cotton covered over the moist places will 
here suffice. 2. Each time a wound is dressed, the hands should 
be disinfected with sublimate (397), and the required instru- 
ments (forceps, needles, etc.) with phenol 5:100, after having 
immersed them for a short time in boiling water. In fact, all 
the articles, which come in contact with the wound, should 
have been previously sterilized — cotton, catgut, silk, drainage 
tubes (416 a k b). 

An irrigator may be improvised by hanging on the wall a 
bottle upside down, out of which has been knocked the bottom, 
and in whose neck by means of a perforated cork, a tube has 
been fitted. 



Skin Diseases, etc. 141 

swelling is to be touched once a day after the applica- 
tion of a bread and milk poultice with a little yeast. 
Abscess. Calomel dusted over the proud flesh twice a 
day, followed by a dressing of Ungt. simplex on lint, 
is used in Ulceration of Umbilicus (of infants). 

401. Iodoform 1.0; Collod. 15.0; 01. Menth. pip. 
gtt. v. Scrophulous and syphilitic swellings, Orchitis, 
Arthritis, Ascites, etc. Iodoform 3 j; Ungt. Petrol. § j. 
Lupus. Half the strength in Variola to prevent pustules. 

402. Iodum 1.5; Pot. Iod. 3.0; Aq. dest. 30.0. Ope 
penicilli applicatur. Tumor albus. Iodum 1.0; Pot. 
Jod. 6.0; Tr. Opii 8.0; Ungt. Petrol. 60.0; vel Iodum, 
Pot. Jod. ^ 5.0; Glycerin 10.0. The application is cov- 
ered with oiled silk and followed after 24 hours by a 
cataplasma. Lupus, Syphilis. Iodine & Phenol (1:4). 
Carbuncle. Applied in time, it frequently will abort 
any kind of boil. 

403. Acid, acet. cone. q. s. The neoplasm is to be 
touched once a day, when it will peel off gradually in 
thin scales. Hypertrophy of skin (Warts and Corns.) 
Acid, chrom., Aq. dest. ana (Servetur in vitro epistom. 
vitreo). Ope penicilli asbest. v. vitr. applicatur. Scir- 
rhus, Warts, etc. Sol. Arg. nitr. ^ per cent, as sub- 
mucous injection in Carcinoma, etc. Zinc, chlor. 1.0; 
Glycerin. 100.0. Cancer , Wounds after operations, etc. 
Benzol brushed over the ulceration, afterwards dusting 
with Calomel 2 — 4 times a week; or Potass. Permang. 
dusted over the sore. Epithelioma. The latter also in 
snake-bite after having vigorously sucked the wound. 

404. Sol. Argenti nitr.( 3 ss — j ) | j. To paint around 
the affected part in order to prevent spreading. Ery- 



142 TOPICALS: 

sipelas. Sol. Ferri sulf. (3.0) 60.0. To brush over the 
affected part; vel Alum. 6.0; Hydr. praec. alb. 0.2; 
Glycerin 20.0. (Useful also in frostbites of second degree), 
Aramon. sulfoichthyolicum p. j, Lanolin p. ij. After 
having covered the wound with a iodoform-gauze- 
coinpress, the erysipelas is to be rubbed with the oint- 
ment and covered with 10 per cent, salicyl. lint. In 
Erysipelas of the face ichthyol-collodion, and of the 
scalp, Ichthyol-soap are said to be preferable. 

405. Ol.Lini &Aq. Calcis ana. Burns. Liq.Ammon. 
2.0; Glycerin 20.0 {for burns of second degree without 
Ammonia); vel Copaiva(also used in frostbites.) Cocain. 
0.1; Glycerin. 20.0. Burns of first degree every five 
minutes until pain relieved. Also good for sore nipples. 
Cocain. 2 per cent., Iodof. ? 3 j; Ungt. simpl \ j. Burns 
of 2d and Sd degree. (If in the face, a gutta percha 
cover will be of service.) Burns from Phosphor are best 
treated with caustic; and extensive burns of any kind, 
either with carbol-spray, and a wet compress of bor-lint, 
(4 per cent.) or, after the vesicles having been opened 
and excised, the entire burnt surface is covered with dry 
iodoform gauze (20 per cent.) over which gutta percha is 
placed. The whole is then protected by gamgee (see 
note, p. 139) kept in position by means of a bandage). 

406. Borax 2.5; Phenol 1.0; Glycerin. 20.0; Tr. 
Opii 1.0; Muc. Acac. 30.0; f or frostbitten ears twice a 
day. See page 3. Acid. nitr. 15.0; Aq.lOO. Chilblains. 

407. Sod. bicarb. & Sod. Chlor. ana. To be applied 
to bites or sti?igs of insects, etc. Liq. Ammon. vel Acid, 
nitricum. Snakebite. See Wounds (poisoned), part. II. 



Skin Diseases, etc. 143 

408. Empl. Cantharid. to nuka in Coma. (Typhoid.) 
Liq. Ammon. fort. gtt. j. As blister, to be repeated 
when healed. Neuralgia. Chloral dusted over Empl. 
adhaesivum and applied after gently heating the plaster, 
will blister in less than 10 minutes, without pain or any 
constitutional effects. 

409. Camphora 3 ij; Alcohol. 3 j; Glycerin. | j. As 
soothing rubefacient. Neuralgia. Spir. Camph., Gly- 
cerin. ^ 50.0. Rheumatism. Linim. Ammon. § ij; 01. 
Terebinth. | j; Tr. Opii § ss. This Liniment without 
opium to be rubbed on the spine at the beginning of 
cold stage in Intermittens. Camphor.3.6; Cetaceum20.0; 
Cera alba 5.0; Ungt. Petrol, albi 25.0. Painful limbs. 

410. Aconitin. 0.5; antea triturata cum Alcohol, gtt. 
aliq. ; Ungt. Petrol. 25.0. Neuralgia. Extr. Aconiti 2.0; 
Glycerol. Amyli 20.0; vel Kali cyan. 0.5; Glycerin. 10.0. 
N. Facialis. (The finger which is used for rubbing 
must have no scratch). Veratrin. 0.3; Morph. hydro- 
chlor. 0.2; Glycerol, simplex 30.0. Migraine. Vera- 
trin. gr. x; Alcohol | ss; vel Chloroform & 01. Olivar. 
ana | ss. Spinal Irritation. 

411. Tr. Cantharid. 3 ij; Tr. Arnicae et Tr. Nuc. 
Vom. "* | j. To be rubbed on the loins and inside the 
thighs. Nocturnal Emissions. Tr, Opii § ss; vel Tr. 
Capsici | j; Linim. Sapon. § ss. Congestion of Kidneys. 
Sparadrap.perfor. Bellad. q.v. Pleuritis {circumscribed). 

412. Lith. carbon. 5.0; Glycerol. Amyli. 30.0. Tophi 
arthritici. Lith.brom. 2.0; Glycerin. 4.0. Pulvis Althaeae. 
et Farina Tritici ^ 2.5; Aqua q. s. ut fiat massa. As 
paste to cover the gouty concretions. 



144 . TOPIC ALS: 

413. Inf. Digitalis ( § j : Oj); vel Ti\ Digitalis, Tr. 
Scillie ^ | ij. To be rubbed twice a day over the 
abdomen, which is then to be covered with flannel. 
Dropsy (if the state of the stomach precludes the in- 
ternal use of diuretics), or Paracentesis.* Tr. Iodi § j 
semel in die to prsecordia. Pericarditis (after effusion.) 
Also in papular stage of Variola. 

414. Collodion; vel Chlorof. § ss; Gutta percha q. s. 
Applicatur semel vel bis die. (In papular stage or if 
vesicles very small. Variola. Sol. Hydr. bichlor. (gr. j) 

§vj; as compresses. At the same time cold water 
compresses on coujunctiva to prevent eruptions there. 

415. Collod. 100.0; Glycerin. 1.5; vel Collod. 100.0; 
01. Ricini 2.0; vel Collod. 100.0; 01. Ricini 1.0; Tere- 
binth, laric. 2.0. Elastic Collodion. Tannin. 3jv; 
Alcohol. 3 ss; iEther. 3 ij; Collod. ad § j. Styptic Col- 
lodion. As protection in all kinds of ulcerative and 
bleeding parts — stitched wounds, etc. Morph., Iod., 
Creosot, or Phenol may be incorporated, if necessary. 

416a. Antiseptic Material — Sublimate 5.0; Acid, 
tart. 20.0; Aq. fervida 900.0; Glycerin. 100.0; Gauze, 
Cotton, etc., q. v. Acid, boricum 10.0 — 20.0; Aqua 
calida 90.0 — 80.0; Gossyp. absorb q.v. Acid. bor. 5.0; 
Acid, carbol. 2.0; Aq. calida 100.0; (Alcohol. 5.0;) 
Gossyp. absorb, q. v.; vel Acid, carbol. 100.0; Spir. 



* After having placed the patient in the recumbent position 
on her side at the edge of the bed, the trocar in a canula being 
held in the hand so that the tip of the forefinger is about two 
inches from the point of it, the instrument is pushed through 
the linea alba, two inches below the umbilicus. In fat persons 
a preliminary incision with the scalpel down to the aponeurotic 
structure will be advisble. 



Skin Diseases, etc. 145 

Colophon. (40.0), 2000.0; 01. Ricini. 40.0; Gossyp. vel 
Lint, q.v.; vel Acid, salicyl. 5.0 — 10.0; Alcohol. 100.0; 
Aqua 200.0; Gossyp. vel Lint. q. v. As dressing for 
wounds, etc. (Absorbent Cotton or Lint soaked in dil. 
acet. acid may be packed between the soft parts of 
lacerated wounds to stop bleeding). 

416b. Sublim. 1:1000; Phenol 3:100; Acid, boric. 
3j: I jv Aq. fervida; Liq. Ferri chlor. c. Aq. fervida 
( 3 Y'l jv); Iodoform, Ether and Alcohol in the propor- 
tion of 1:2:8. For medication of sponges. Before 
sterilizing the sponges by boiling they should be thor- 
oughly cleansed with soft soap (potash,) or, if necessary, 
washed with hot water containing hydrochloric acid. 
Silk for sutures should be treated with sublimate 1 : 1000? 
after having been boiled for half an hour; or it may be 
impregnated with beeswax containing 10 per cent, 
phenol. Catgut is made aseptic by shaking it with 
ether and then preserving it in 01. Eucalypti. (Nos. 1 & 2 
are the best sizes for sutures and small ligatures). Before 
use it must be dipped in Alcohol to make it pliable. 
Drainage tubes (1-16 — 1-4 inch by 12 inches) are made 
aseptic by soaking in phenol 5:100 — glass tubes maybe 
kept in sublimate 1:1000 after having been boiled. 

41 Y. Hot-air-bath. Heated air is introduced under 
the bed clothes for the purpose of producing diaphoresis, 
if Hydragogues are not borne and Diuretics will not act. 

Sulphur-air bath. Sulfur § ss — j is burnt in the sick 
room, which has to remain closed for a few hours to 
allow the fumes to permeate it thoroughly. After hav- 
ing the room thus disinfected, the patient is taken back. 
Infectious Diseases. In Pertussis said to be specific. 



146 TOPIC ALS: 

418. Lime-steam-bath. A barrel of quick-lime is 
slackened in the room daily, whilst the latter is charged 
with steam by keeping water boiling all the time. 
Croup, etc. 

419a. Pot. sulphuret. § jv; Aqua C.30, as bath in 
wooden vessel. Lead colic. Pulv. Sinapis § j; Piper 
rbr. | ss; for a bucketful of warm water, as styptic bath. 
Dysmenorrhea, etc. Pulvis Sinapis § jv for a foot bath, 
lb \ for a hip — and lb. j for a full bath. Best stimulant 
for internal congestion. 

419b. Ferr. sulfuricum crudum 100.0 (No. I); Acid* 
tartaricum 20.0 (No. II); Natr. bicarb. 10.0 (No. III). In 
this succession the substances are to be dissolved. 
Balneum ferrugin. mitius . Ferrum sulfuricum cr. 1 5 . ; 
Sal. marin. 300.0; for one bath. Balneum fortius; vel 
Ferrum tartaricum 75.0 — 100.0. 

420. Sponging with water, or brandy and water, if 
the skin be hot and dry, and axillary temp. 104 degrees 
or more; or the Wet Sheet with a sprinkling pot of cold 
water to be kept up for several hours if necessary — 
— according to temp, and pulse. In Insolation. In 
functional Paralysis, Douches of alternately cold and 
warm water; or the Wet Pack: The patient is enveloped 
in a wet sheet and closely covered with blankets. In an 
hour's time, when perspiration is induced, the pack is 
removed, the body wiped dry and the patient placed in 
bed. In acute Ascending Paralysis the pack is some- 
times of great service. In Bronchitis capillaris — where 
the child should remain packed for from four to six 
hours — in conjunction, if necessary, with a wet compress 
round the neck, taking care that the latter overlap the 



Skin Diseases, etc. 147 

chin (298b). In Cholera epidemica, the modified pack: 
Hot water, with or without a dash of vinegar, being 
substituted and renewed every two hours.* In Inter- 
mittens and Yellow fever, sponging, and internally ice- 
water ad libitum. In Articular Rheumatism, acute and 
chronic, the pack or sponging. In Scarlatina and 
Measles the same, once or twice a day. In Typhoid, 
sponging with cold water, whenever axillary temp. 103 
degrees or over, or that of rectum 102-J- degrees, as long 
as it is attended with comfort, until it falls to 101 
or 100 degrees; or wrapping in a wet sheet and sprink- 
ling at intervals, whilst the thermometer in rectum. 
(A cot with arrangements for the drainage is convenient.) 
A sensation of chilliness, feeble pulse or cyanose contra- 
indicate the continuance and call for wine and spirits. 
Cold water is altogether contra-indicated if there be in- 
testinal hemorrhage, sweating, menstruatio?i, feeble pidse 
or feeble action of the heart. For compresses in affec- 
tions of throat or in Variola, see Nos. 298 & 414. 

421. Electricity. Galvanism is chiefly used for its 
catalytic, cataphoric and electrotonic action. f In Melan- 



*If the sheet be washed directly after its use in water, con- 
taining Chlorin. Soda, three, with as many blankets,will suffice 
for the procedure; in as much the evacuations will generally 
cease in the first pack. The stools should be voided into a 
vessel containing Ferrum sulfuricum ; and if the dejections are 
passed involuntarily, they must be received on cloth wrung in 
vinegar. Moreover all the articles of cloth should be cast, as 
soon as removed from the patient in a wash-tub containing 
chlorinated water. Vinegar or phenol should be added to the 
wash water for the use of the attendants. 

|When the galvanic current is applied for the catalytic effect, 
no interruptions should be allowed in the circuit — these are, in 
fact, only required in examination of electrical motility, and for 
therapeutic use, in cases where the Faradic current fails to 



148 TOPICALS: 

cholia, Functional Insanity and some other diseases of 
the brain, especially Intracranial Syphilis, before 
hemiplegia has supervened, a galvanic current is some- 
times of service. The electrodes must be placed in the 
nape of the neck and on the forehead; the strength of the 
current may be gradually increased to about 2 milliam- 
peres, and one sitting should not exceed 3 minutes. In 
organic disease of the brain and spinal cord it will gen. 
erally retard trophic changes and relieve certain symp- 
toms attending those affections — as pain, anaesthesia, 
spasm, paresis. In cerebral lesions the diseased peri- 
pheral structure should be treated at the same time with 
Faradization. In Facial Paralysis^ in order to reach 
the medulla oblongata, one pole should be placed in 
nuca and the other above the larynx. In Neuralgia, 
where the pain is increased by pressure, a mixture of 
Cocaine and Aconite may be introduced under the skin 
by means of the current, or two needles may be deeply 

obtain motor response, viz., in cases of infantile paralysis, lead 
palsy and all those peripheral palsies produced by pressure or 
trauma, which present the reaction of degeneration. It should 
be only so much increased as to cause the slightest sensation of 
a change, while the Faradic current should produce but a 
pleasant tickling. (Very sensitive people will bear the latter 
better, if they have been exposed to a moderate volume current). 
One of the electrodes should be placed as near as possible the 
seat of the disease, the other being applied so that the direct 
route of the current includes the locus morbi. The choice, of 
the poles will depend on trial, as the difference in the action of 
anode and kathode is not yet understood. 

Faradization is limited to an artificial stimulation of motion 
and sensation; it will act better than the galvanic interrupter 
in cases requiring muscle stimulation, with the exception of 
those characterized by the reaction of degeneration. The slow 
interrupter will generally be required for treatment, since 
many muscles, suffering from local or centric disease will re- 
spond to single stimuli that remain totally impassive, when the 
rapid succession current is employed. 



Skin Diseases, etc* 149 

inserted at 2 points in the course of the nerve (galvano- 
puncture). Hysterical Neuralgia is more benefited by 
Faradization, which is brushed over the painful points. 
In Hypercesthesia and Ancesthesia the rapid interrupter 
must be used. The sensorial sedative action is obtained 
by means of moi^t electrodes, the anode being the pole 
applied locally; whilst the stimulating effect is pro- 
duced by the use of a dry electrode, the kathode being 
the local pole — the moist anode may be placed anywhere. 

422 To remove superfluous hair. After having intro- 
duced the negative needle into the follicle, hard by the 
hair to be removed (which has been grasped with the 
epilating forceps), the patient, with the sponge electrode 
in one hand, is directed to press the sponge against the 
palm of her other hand. In about one minute the hair 
will be found loose, and may now be removed — but 
without traction — taking care not to withdraw the 
needle before the patient has broken the circuit. More 
than three dozen of hairs should not be operated upon 
at one sitting. A battery of 10 cells are sufficient (3 — 5 
milliamperes .) Small Ncevi, Angiomata or Erectile 
Tumors, Warts, Hairy Moles and other small growths 
are also readily removed by galvano-puncture. Sub- 
sequent fomentations are sometimes of service. Ence- 
phaloid, Scirrhus and other malignant tumors are occa- 
sionally amenable to cure, but require several operations 
at intervals of from 3 — 5 days. Goitre may be success- 
fully electrolysed, if the tumor be of a yielding con- 
sistence and not of too long standing. With the sponge 
electrode in nuca, introduce a gold tipped negative 
needle into the tumor, being careful to avoid the large 



150 TOPICALS: 

superficial veins. The strength of the current should 
not exceed 20 milliamperes, and the weekly sittings 
5 minutes. In the cystic variety, both poles must be 
introduced into the sac by means of needles. In Hydatids 
(of the liver) 2 negative needles are introduced into the 
most prominent part of the tumor, about 2 inches apart, 
and over the hepatic region a sponge electrode is kept 
slightly moving for about 15 minutes. In Aneurism, 
both the negative and positive needle are introduced 
into the sac at about 2 inches distance from each other. 
5 — 20 cells are required, and the operation may last for 
one or two hours. The introduction of 3 or 4 positive 
needles has been lately recommended. Varicose Veins 
of the legs are said to disappear sometimes altogether 
under the Faradic treatment. 

423. Extra-uterine Pregnancy has been treated suc- 
cessfully by the Faradic current from a strong inductive 
coil, one electrode being pressed against the tumor in the 
vagina and the other to the abdomen. The destruction 
of the foetus by electrolysis is applicable during the 
first four months, and the operation, which should not 
exceed one hour, has generally to be repeated 3 or 4 
times at intervals of about 3 days. 

224. Artificial Respiration. After having passed a 
needle into the Trapezius, or beneath the skin, imme- 
diately over the JPomum Adami, the moist sponge 
electrode is applied a little below the Sternum. The 
contractions of the diaphragm and chest muscles is now 
sustained just long enough until one leisurely may count 
three, when the sponge is removed, to be reapplied after 
a similar interval. See page 1. 



HPPENDIX. 



3. Table of Weights and Measures, etc, 
2. Analysis of Urine. 



152 



Table of Metrical and 



METRICAL WEIGHTS. 

0.001 (Milligram) _ 0.015 gr. (&) 

0.01 (Centigram) _ _ 0.154 " (J) 

0.1 (Decigram) 1.543" (If) 

1.0 (Gram=l C.C. of water at 4° Celsius).. 15. 432 " (15) 

10.0 (Decagram) —%% drachms 

100.0 (Hectogram) ; 3 ounces 

1000.0 (Kilogram) _ 32 " 



Table for Converting Apothecaries' Weight into Metric. 



Troy Weight. Grams. 
1-60 of a Grain O.001 



Troy Weight. Grams. 

36 Grains.. 2.33 



1-30 " 
1-20 " 


..O.002 
. .O.003 
_ .0.004 
.. .O.005 
..O.006 
.-O.008 
-O.011 
..O.016 
..O.022 
. .0.032 
..O.05 
..O.065 
-0.13 
.-0.19 
-0.26 
-0.32 
.-0.39 
..0.52 
.0.65 
.0.78 
.0.97 
-1.04 
-1.17 
..1.30 
-1.55 
..1.95 


40 
50 
60 
80 
90 
96 
100 

2 

21 

3 

4 

6 

1 

1* 

2 

21 

3 

4 

5 

6 

7 

8 

9 
10 
12 
16 


a 

a 
a 
tt 

a 
a 

Drac! 
tt 

t% 

u 

tt 

Ounc 
a 

Ounc 
tt 

u 

a 

tt 

a 

a 
tt 

u 
a 
tt 
a 


(3ij)~ 


— 2.60 
... 3.24 


1-16 
1-12 
1-10 
1-8 " 


(30- 
Ojv)- 

( 3 jss) 


... 3.90 
... 5.18 
— 5.83 
... 6.22 


1-6 
1-4 

1-3 " 


(3v)„. 
lms 


... 6.48 

... 7.75 
... 9.72 


1-2 " 




... 11.66 


3-4 " 




... 15.55 


1 Grain 




... 23.3 


2 Grains 

3 " 


e 


.. 31.1 
.. 46.6 


4 " 


es 


... 62.2 


5 " 


... 77.7 


i 
CO oc 


• 


_. 93. 
..124. 


10 " 


..155. 


12 " 


-186. 


15 " 


..217. 


16 " 

18 " 

20 " O'j) 

24 " 

30 " (3ss)„. 


..248. 
„279. 
-311. 




..372. 
..500. 



Apothecaries' Measures, etc. 



153 



APPROXIMATE EQUIVALENTS OF CUBIC CENTIMETERS. 

0.001 C. C.= it Minim. I 0.1 C. C.=.— H Mmim. 

0.01 u = I " I 1. " = 15 

[The weight of 1.0 water at its maximum density— 39.2° 
Fahrenheit — see preceding page.] 

4 C. C. — f . 3 j Cochleare parvum (Teaspoonf ul). 

8 " =f. 3 ij Cochl. medium (Dessertspoonful). 

16 " =f. 5 ss Cochl. magnum (Tablespoonful). 

48 " =f. 5jss Cya thus vinosus (Wineglassful). 

160 " =f. §v Vasculum pro thea (Teacupful). 

320 " =f. §x — Cyathus (Tumblerful). 

500 " =Oj Octarius (Pint). 

1000 " =Oij Litre (a little more than a Quart). 

4000 " =Cj Congius (Gallon). 

Table for Converting Apothecaries' Measure into Metric Weight. 



*0Q 


GRAMS 
FOR LIQUIDS. 


*0D 

H . 

M M 

M 
ga 


GRAMS 
FOR LIQUIDS. 


DP 

si 

Pi 

< 


^3 


OS 


u 

.8 « 

-t-J 






«3 


MINIMS. 
1 


.055 
.10 
.16 
.22 

.28 

.32 

.38 

.45 

.50 

.55 

.65 

.76 

.80 

.90 

1.12 

1.40 

1.70 


.06 

.12 

.18 

.24 

.30 

.36 

.42 

.50 

.55 

.60 

.72 

.85 

.90 

1.00 

1.25 

1.55 

1.90 


.08 

.15 

.24 

.32 

.40 

.48 

.55 

.65 

.73 

.80 

.96 

1.12 

1.20 

1.32 

1.60 

2.00 

2.50 


MINIMS. 

35 

40 

50 

60(f3j)- 

72 

80-.-™. 

90 (f 5jss). 

96 

100 

120(f3ij)- 
150 (f 3 ijss) 
160 

180 (f 3iij)- 

210(f 3 iijss) 
240(f3jv). 

f§i 

f §jv 


2.00 

2.25 

2.80 

3.40 

4.05 

4.50 

5.10 

5.40 

5.60 

6.75 

8.50 

9.00 

10.10 

11.80 

13.50 

27.0 

108.0 


2.20 

2.50 

3.12 

3.75 

4.50 

5.00 

5.60 

6.00 

6.25 

7.50 

9.50 

10.00 

11.25 

13.00 

15.00 

30.0 

120.0 


2.90 


2 


3.30 


3 


4.15 


4 


5 00 


5 


6,00 


6 


6 65 


7 


7 50 


8 


8 00 


9 

10 


8.30 
10.00 


12 

14 


12.50 
13.30 


15 


15.00 


16 ._ 


17.50 


20 

25 


20.00 
40.0 


30 


160.0 



Age. 

1 to 3 months 

4 to 12 " 

1 to 3 years 

4 to 5 " 

6 to 8 " 


Dose. 

1-16 

1-10 

1-6 

1-4 

1-3 

1-2 


Age. 

13 to 16 years 

17 to 20 " 

21 to 50 " 

51 to 60 " 

61 to 70 " 


Dose. 

... 2-3 

3-4 

1 

3-4 

2-3 


9 to 12 " 


80 to 90 " 


1-2 



A FEW OBSERVATIONS ON URINE AND 
HOW TO TEST IT. 



The quantity of urine passed by a healthy person in 
24 hours varies from 30 — 40 ounces, and its color will 
likewise vary very much, being like the quantity, in 
intimate relation with the ingesta. Though usually of 
a light amber or straw color, it may take all possible 
shades between water and porter. Among drugs that 
have a decided coloring influence on the urine, which, 
in some instances, might be taken for blood, may be 
mentioned Curcuma, Rheum, Frangula, Senna and 
Santonin. — A few drops of hydrochloric acid will settle 
the question, in as much bloody urine undergoes no 
change. 

Very pale urine, if not the consequence of much 
drinking, may be due to Ancemia, Chlorosis, Hysteria, 
Diabetes, etc., etc. 

High colored urine indicates generally an excess of 
acid, and unless the result of good living, is symtomatic 
of febrile diseases. 

A smoky tint is diagnostic of the presence of blood. 

Deep yellow or greenish brown indicates bile due to 
hepatic disorders. 

Dark brown or black urine is generally due to rapid 
morbid changes in the blood and tissues, and occurs in 
infectious and other severe diseases. 

Cloudy or filmy urine is generally alkaline and indi- 
cates the presence of mucus; white opaque and viscid — 

(154) 



Analysis. 155 

mucus or pus or earthy salts, singly or jointly. Turbid 
urine of a creamy yellow color at the bottom is mostly 
acid and contains pus. 

Froth on healthy urine readily disappears, but if it 
be permanent the presence of albumen or the constitu- 
ents of bile may be suspected. 

The odor of urine is also of much importance. A 
smell of Ammonia indicates catarrhal inflammation of 
the bladder; that of Sulfurated Hydrogen occurs in 
Typhoid and Cholera, and is a bad omen. (The admin- 
istration of 01. terebinth, produces a smell of violets). 

The specific gravity of urine averages about 1020. If 
higher, sugar or uric acid are most likely to be present: 
a low spec, gravity is frequently observed in Hysteria 
and ancemic conditions; in chronic Bright' $ disease and 
in Diuresis from any cause. Blood and fibi*in may be 
detected by the microscope, and the presence of serum 
is ascertained by the discovery of its albumen, on 
account of which serous urine is commonly called 
albuminous urine. 

The urine to be examined should be always a portion 
of the lohole quantity passed in 24 hours, because that 
passed in the morning frequently contains no albumen, 
whilst that voided later, does. Urine, not distinctly 
acid, should be rendered so before testing for albumen, 
by adding a drop or two of nitric or acetic acid; and if 
it be permanently turbid from any cause, it should be 
filtered before boiling. In that case the presence of 
mucus or pus may be suspected, whilst a turbid urine 
becoming clear by boiling contains urates. (If the urine 
has not been acidulated before boiling, the cloud or 



156 A Few Observations On Urine 

opacity, which may appear might be due to the presence 
of Earthy Phosphates, which, of course, will be redis- 
solved on the addition of the acid). 

Renal casts should always be sought for, if albumen 
is detected: Allow the urine to settle for a few hours 
in a tall glass, then, after having poured off all the top, 
place a drop of the residuum under the microscope,where 
the fibrin will readily be distinguished. 

Sugar. Unless the spec, gravity of the urine rise 
above 1030, it is of no practical value to examine on 
sugar, in as much, 15 grs. of it are excreted daily 
through the kidneys by a healthy person. Put a few 
drachms of urine in a test-tube, add the same quantity 
of Liq. Potassce, and heat to boiling-point over a spirit 
lamp, when, according to the quantity of sugar present 
in the urine, it will assume a dark-brown, even black 
color. It is, however, necessary to remove any albumen 
before testing for sugar, by boiling the urine in question 
with a drop of acid, and subsequent filtration. If there 
be no albumen, and a few drops of nitric acid be added, 
the dark color will disappear, the urine exhaling a smell 
of molasses. (Aside from albuminous urine, a urine 
high colored or containing an excess of Phosphates, will 
considerably darken on boiling with caustic alkalies). 

To estimate the amount of sugar, put two 12 oz. 
bottles, each containing 4 ounces of the urine to be 
tested, for 24 hours in a warm place, the one tightly 
corked and the other with a piece of yeast, the size of 
a chestnut, thrown into the urine and not corked. The 
difference in the spec, gravity will give the number of 
grains of sugar contained in the fluid ounce. 



And How To Test It. 157 

Mucus and Pus. Pus produces a thick sediment at 
the bottom of the urine, which is rendered viscid and 
gelatinous by the addition of about half its quantity of 
Liq. Potassce; whilst urine containing mucus, which is 
stringy and floating rope-like within it, becomes more 
fluid and limpid under these circumstances. (Pus from 
the bladder will probably be mixed with mucus consti- 
tuting muco-purulent matter.) 

Bile-pigment may be detected by shaking the sus- 
pected urine with a small quantity of Chloroform. If 
bile be present, a yellow sediment will form, consisting 
of bilirubin crystals.* 

Spermatozoce. Allow about a quart of the urine to 
be tested to settle for a few hours in a tall glass, decant, 
and divide the rest of about 8 ounces in two pointed 
champagne glasses to settle for another 5 or 6 hours, 
after having added to the one a little Picric acid. 
Decant again and place a drop of the urine remaining 
in the two glasses under the microscope. 

To detect Spermatozoce in linen, a few threads of the 
stained piece should be moistened with a drop of 
Gallic acid, dissolved in water, to which must be added 
after about 10 min. a drop of Sol. Ferri chlor. dil. 
A few threads may now be prepared in the usual man- 
ner for microscopical examination, by means of a needle 
in a drop of glycerine. 

*Boiling of the acidulated urine in a test-tube, will in most 
cases suffice. Originally turbid urine, remaining so when boil- 
ing, contains Mucus or Pus— clearing up: Urates; whilst ori- 
ginally clear urine becoming turbid by heat, contains either 
Albumen or Phosphates, the latter if it clears up by the addition 
of an acid. Compare Urinary Deposits, part II.) 



THE SECOND AND THIRD VOLUME 



The General Practitioner 

(see contents of this volume), 

Will respectively appear in December, 1889 
and February, 1890. 



The order, accompanied by $1X0, or for the whole work 

(3 volumes) $3.00, should be registered 

and addressed to 

DR. STREHZ, 
380 Wells Street, CHICAGO, Ilii* M U.S.A. 



PART II. 

An Alphabetical Arrangement of the Diseases, 
'with their several definitions, symptoms (whenever pos- 
sible pathognomic), and causes, together with diagnostic 
hints, and the remedies usually employed in their treat- 
ment. 



Abortion — Expulsion of the contents of the gravid 
uterus, before the seventh month of utero-gestation, i. e. 
before the viability of the foetus; attended by pain, 
which is marked by distinct intervals, like those in labor, 
and more or less hemorrhage, which, unlike that from 
delayed menstruation, usually precedes the pains, the os 
being at the same time more open — see Labor. Aside 
from blows, falls, or acute disease of the mother, and 
morbid conditions of the foetus, it may be caused by 
strong emotions; irritation of nerves — of the trifacial, 
from the extraction of a tooth; — excessive sexual ex- 
citement; violent purgation; anaemia; tumor in utero, 
ulceration of cervix, etc., etc. Treatment — Until dila- 
tation of the os, or the partial extrusion of the ovum 
is obvious, abortion may be prevented sometimes by 
complete rest; Morph. with Brom. (51) internally, and 
Bell., Opium, etc., as suppository, or enema (375 & 
81). If there be plethora or feverishness, Nitre (123). 
In threatening or habitual abortion, Viburnum (p. 39); if 
want of nausea be suspected as cause, Ipecac, (p. 100). 
Proper attention should be paid to the uterus, for, if that 

(159) 



160 Abscess. 

organ be fleeted to such a degree as to produce incarcera- 
tion of the fundus below the promontory of the sacrum, 
abortion is sure to follow. In case where prevention is 
impossible, the expulsion of the ovum, which in the 
first three months generally escapes entire, must be 
facilitated, though as a rule, the less we interfere th<* 
better. Should the ovum project, one may try to shell 
it out by means of two fingers which have been well 
greased, carried up to the os, while the right hand is 
applied externally to press down the womb and assist the 
operation. If unsuccessful, one drachm of Tr. Ergotae 
every 15 min. ex aqua. After three months, if the foetus 
has been extruded, we may leave the placenta alone, as 
nature is sure to expel it; though we may have to wait 
for more than a week, and Ergot would be of no use. 
Only in case of flooding, which in reality is the danger, 
it will be advisable — see Hemorrhage. To prevent sep- 
ticaemia Aconite or Veratrum may be given with Sa/icin 
(pp. 22 and 39), according to the strength of the pulse. 

Abrasion of Cervix. See Uterus (Granular degen- 
eration of cervix). 

Abscess — A cavity filled with pus in consequence of 
disintegration of the substance of an inflamed organ — 
compare Tumors and Ulcers. Treatment — Aside from 
due attention to the general state of health, ice or cold 
water compresses to check the formation of pus; or fo- 
mentations and poultices (400) to hasten maturation; and 
the knife. After evacuation of the pus, antiseptic dress- 
ings: Phenol (327 & 398); Phenof~lod. (402); Mangan 
(334 & 403); Bor (260); Iodoform (269 & 401); Salicin 
(399); Resorcin (335 & 396); etc. Internally Sulfides 
(p. 19) and perhaps Tonics (p. 69). F 'or fecal abscess see 



Alcoholism. 161 

Typhlitis; Mammary — Breast; Pelvic — Uterus (Cellu- 
litis); Retropharyngeal — Pharynx; Vulvar — Vulva, etc. 

Aciditv of Stomach. See Dyspepsia. 

Acne. See Skin. 

Adipositas. [Fettsucht of the Germans.)— Obesity is 
mostly the consequence of excessive ingestion of food, 
especially of fat and carbohydrates — the latter by pre- 
venting oxidation — under certain circumstances and 
constitutional peculiarities, as, e. g. is sometimes the 
case in the climacteric period of females, when the 
ovaries get into a state of atrophy; or in males, from 
defective action or development of the testes. Treat- 
ment — Alkalies (p. 53); Fucus? (p. 12), with appropriate 
diet and plenty of exercise. An excessive accumulation 
of fat connected with menstrual aberration to be met 
with in young women, will frequently disappear, if the 
latter can be corrected. 

Ague. See Fever (Intermittens). 

Akinesis. See Paralysis. 

Albuminuria. See Kidney. 

Alcoholism — A toxical condition produced by abuse 
of alcoholic drinks, and culminating in delirium tre- 
mens — Mania a potu, — which is both, either the direct 
consequence of the long, continued action of alcohol 
on the brain, or due to the sudden withdrawal of. alco- 
holic stimulants in an habitual drinker. It is charac- 
terized by mental aberration, the mind wandering from 
one subject to another, and incessant talking, accompa- 
nied by a wild expression, the eyes being either vacant 
or staring. The mental disorder is preceded for a few 
days by the horrors: Muscular tremor, mental depres- 
sion and insomnia, attended by complete anorexia. A 



1 62 Amenorrhea. 

form of acute mania, due to active cerebral congestion, 
and produced rather by a protracted paroxysm of drink- 
ing, than by the habitual use of alcohol (Delir. Ebrios.), 
is characterized by great hilarity, even violence and 
fury, which may, of course, eventuate as well in Delir. 
tremens. Treatment — In kater, Amman, (p. 44); Acid; 
hydrochlor. (p. 42). In debility and craving for drink 
[Dipsomania), Antimony (39); Acid. sulf. (155); Ammonia 
( 159). In vomiting, Gelsem. (p. S3), see Vomiting. In 
anorexia, Capsicum (165); Quinine (16V); Zinc (p. 86). 
In coma — dead-drunk — Cold douche or Tablesa/t (p. 101); 
Croton (225); see Coma. In delirium ebrios., Cold 
douche and Croton ; Brom and Cannabis (pp. 21 & 28); 
Catechu. (135). In insomnia preceding delir. trem., Brom 
(49-53); Chloral (pp. 30 & 109). In delirium tremens, 
Antimony, Brom, Digitalis (p. 79); Cocaine (pp. 11 & 109); 
4 doses of Capsic. pulv. 3 ss taken hourly, are said to 
have induced sleep, followed by profuse perspiration 
and urination. 

Alimentation. See Inanition. 

Amaurosis and Amblyopia. See Eye (Vision). 

Amenorrhcea — The absence — Retentio — or stoppage, 
— Suppressio—oi the menstrual flow. The former due 
to general debility; absence, or imperfect development 
of the ovaries; imperforate os tincae, etc., the latter 
mostly a consequence of disease; cold; fright; etc., etc. 
Resulting from pregnancy or menopause, which latter 
may occur even before the thirtieth year of age, it is, of 
course physiological. Treatment — Above all, removal 
of cause: If stricture of cervix, or uterine engorgement, 
see Uterus; ovarian dropsy — Ovaries; hemorrhage from 
any organ not connected with ovulation — -Menstruatio 



Anaemia. 163 

vicaria, etc. In functional inactivity of the ovaries, 
Ars. (p. 10); tod. (pp. 14 & 15); Cantharis (p. 47); San- 
guin.(p. 41); Sabina(p. 86); Ergot (172); Mangan (182); 
Electricity; Hipbath and Pediluvia. If anaemia, Ferr. 
(174 & 197); 4c/V. s*///. (155); Guagac. (p. 12). If sud- 
denly checked; Aconite (p. 23); 4/0gs (p. 89). In con- 
stipation or palpitation, Salines (219); if pulse strong, 
Croton (225). If from cold or fright, Calomel (p. 93), 
with Mustard Bath (419), a few nights preceding the 
expected period; and Aloes c. Myrrha (p. 89), every 
second night. If plethora, eight ounces of blood from 
the arm. Mercury is the best deobstruant in suppression 
of long standing, as there is always more or less con- 
gestion of the uterus; when it has to be given until 
ptyalism, Calom. (12) at first; afterward at intervals of 
four or five days, as circumstances may require, to keep 
the mercurial action up for at least three or four months. 
A scrophulous diathesis, inflammatory affections, accom- 
panied with exhaustion, nervous irritability, etc., which 
prohibit its use, demand Iodine (p, 15); Quinine (pp. 75 
£ 76); Strychnine (p. 89), etc. 

Anaemia — A condition mostly dependent on a dim- 
inuition in the mass of the blood, the number of the 
red corpuscles and in the amount of haemoglobin in the 
latter — the Liquor Sanguinis being poorer in albumen 
and containing an excess of salts. See Chlorosis, Leu- 
cocythaemia, and Heart (Valvular lesions). Treatment 
— Aside from good nourishment, plenty of exercise in 
the open air, bathing and sponging with cold water, 
Chalybeate Waters, and Cod-Liver Oil. Ferr. (197); or 
if it disagrees, Ars. (p. 9); Quinine (166); Mangan, Strychn. 
(pp. 82 & 83); Asa foetida (41). If spinal or cerebral, 



164 Anasarca. 

Cocaine (p. 11). If constipation, Tonic Purgatives (p. 
95). If monorrhagia, Acids (129, 154), etc. 

Anaesthesia and Analgesia. See Neuritis reap. 
Paralysis. 

Anasarca [Subcutaneous Oedema) — A serous transu- 
dation into the interstices o £ connective tissue, extend- 
ing over the greater part of the body. See Dropsy. 
Treatment — Quinine (166), if anaemia; if from gestation, 
Calomel (210). 

Aneurisma — -A circumscribed dilatation of an artery, 
dependent on a lesion of its coats. Treatment — lod. c. 
Ferro (p. 14); or Veratr. (p. 39); and compression of 
the artery between the affected part and the heart, if not 
contra-indicated by inflammation, to retard circulation, 
and thus cause deposits of fibrin. (Injections of Tinct. 
Ferri chlor. or Ergot into the sac, to cause coagulation 
of the blood, are always more or less dangerous.) Elec- 
tricity (p. 150), is sometimes of service. 

Angina Ludovici — Acute suppurative inflammation 
of the connective tissue around the submaxillary gland 
— always dangerous. Treatment — Poultices or fomen- 
tations, and when there is the least sign of fluctuation, 
an incision and cleansing the wound with Antiseptics. 
Phenol (327). See Abscess. 

Angina Maligna and Membranacea. See Diph- 
theria resp. Laryngitis exudativa. 

Angina Pectoris — A neuralgic affection, character- 
ized by a severe constricting pain, emanating from the 
praecordia, and radiating thence upward in different 
directions, accompanied by feelings of extreme anguish. 
The paroxysms are sudden, and mostly of a few minutes 
duration; however they may last for hours, and if asso- 



Anus. 165 

eiated with heart disease, may prove fatal. Treatment 
— Aside from swallowing pieces of ice, revulsives to 
chest and extremities (408 to 411), or brandy (p. 73); 
Lobelia (p. 34); Cocaine (168); Morphia hypoderm. (255); 
Amyl as inhalation ( 3t)8 ). Arsenic (p. 9), is said to lessen 
the severity of the attacks and prevent them by degrees. 
In gouty habits, Colchicum (105). 

Angioma. For the simple and the cavernous variety 
see Naevus; for the villous form, Urethra. 

Anteflexion and Anteversion. See Uterus. Dis- 
placements). 

Anthrax. See Carbuncle. 

Anus — Fissura Ani — A small chap, crack or ulcer,, 
giving intense pain during the passage of a motion, and 
even for hours after. Treatment — Free purgation (pp. 
95 to 97); and locally, Tannin (360); Iodoform (373); 
Cocaine, Plumbum, Salicin, (396 to 399), etc. 

Fistula in Ano — A fistulous track by the side of the 
rectum, through the fibres of the sphincter ani, in con- 
sequence of ulceration of the mucous membrane. Treat- 
ment — Copaiva (106), and tonics (p. 69); and locally, 
astringent and stimulating injections (361, 364 and 378); 
or the ligature. The only effective cure, however, is 
the knife: division of the sphincter, etc. 

Prolapsus Ani — An eversion of the lower portion 
of the rectum, and its protrusion through the anus. 
Treatment — Catechu or Ferrum, as injection (378). See 
Rectal diseases. 

Pruritus Ani — A violent itching of the anus, gen- 
erally complicated with a fissured state of the surround- 
ing skin. Treatment — Sublimate (339); Caustic (343); 
Atropine, Creosot, Phenol (350, 352 & 372). At the same 



166 Aphonia. 

time alkalies or perhaps a tonic treatment (pp. 54 & 69). 

Atresia Ani — A congenital closure of the rectum. 
Treatment — The infant having been placed on its back, 
and the thighs elevated by an assistant, so as to expose 
the occlusion, an incision is made with a bistoury. A 
small pledget of lint, greased with some ointment, is then 
introduced and kept there for two days. Afterward an 
injection of a little warm water should be given to pro- 
duce a free evacution. 

Aphonia — Loss of voice, due to paralysis of the spinal 
accessory — unless it be the result of laryngitis — and 
frequently associated with hysteria. It may occur from 
pressure on the recurrent laryngeal by some tumor; or 
he a consequence of cerebral embolism and thrombosis. 
If purely a functional affection, the whisper is soft, but 
clear, whilst if due to inflammation, it is husky and 
labored. Treatment — Aside from shower-baths and pro- 
per attention to general health, counter-irritants (408 & 
11); Belladonna plaster or electricity, (p. 148), provided 
it be simply neurotic, without involving lesions in the 
nervous centers, nor pressure on either, the par vagum 
or the recurrent laryngeal. 

Aphthae. (Stomatitis simplex.) See mouth. 

Apoplexy — A sudden loss, more or less complete, of 
sensation and motion in consequence of some kind of 
pressure on the brain. See Brain (Hyperaemia). Treat- 
ment — The head should be moderately raised, the cloth- 
ing round the neck loosened and stimulating applica- 
tions (409 & 11) to extremities if cold. If from active 
congestion, cold compresses to the head; Calomel (p. 92); 
Croton (225 & 385); Belladonna (p. 23); or Atropin hy- 
podermically (241); Aconite (p. 22); bleeding, etc. If 



Asphyxia. 167 

from passive hyperaemia or embolism, brandy (p. 73), 
to prevent paralysis of the heart. 

Arthritis — A specific inflammation dependent on 
lithaemia, and accompanied by the deposition of urate 
of soda in and about the joints, especially of the feet and 
hands. Aside from a considerable redness of these 
joints, gout is characterized by severe nocturnal pains 
in the first joint of the great toe; and generally asso- 
ciated with digestive disturbance. Treatment — The 
limb should be kept in an elevated position, and after 
having painted the joint with lodof. (401), covered well 
with cotton. For the relief of pain, Opium, Bell, or 
Hyoscyamus (pp. 23, 33 & 35); if feverishness, Aconite 
(p. 22); salines (p. 96); Aloes (200); Lithium (110), Salicin 
(27&30); Guajac (11). The diet must be light. In the 
chronic form, Iodine (p. 14 and no. 402); salines (220), 
and alkalies (pp. 53 & 97); if flatulency Ammon. (93). In 
rheumatic gout, alkalies; Salicin ; Colch. (pp. 48 & 90); 
Benz. (p. 46); Arsenic (2). In Arthritis nodosa, Salicin (p. 
18); Lith. (412), as application to the gouty concretions. 

Ascarides. See Helminthiasis. 

Ascites. See Hydro-Peritoneum. 

Asphyxia Neonatorum — An infant at birth appar- 
ently lifeless. Treatment — If a child be born in an 
apoplectic condition, as shown by swelling and lividity 
of countenance, the cord should be divided at once, 
and about two teaspoonsful of blood allowed to escape. 
Any mucus or clot must be removed from the mouth; 
the face exposed to the air and sprinkled with cold water; 
or the child may be dipped alternately into a cold and a 
warm bath; or artificial respiration. For Asphyxia from 
drowning, hanging, etc., see page 1. 



168 Asthma, 

Asthma bronchiale s. nervosum — A paroxysmal 
difficulty in breathing, which is of a wheezing char- 
acter, and associated with a distressing cough, depend- 
ent on a spasm of the muscular fibres of the smaller 
bronchi, bronchitis or emphysema frequently co-exist- 
ing. (A peculiar combination of asthma with coryza 
and bronchitis, occurring in summer in persons with a 
peculiar idiosyncrasy, is called Hay- asthma.) The 
paroxysm is characterized by a sense of constriction, 
coupled with a feeling of great anxiety, the patient not 
being able to recline. Treatment — During the fit strong 
coffee may be tried; inhalations of Chlorof. (304); Asa 
foBtida (311), or Nitre (325); Brom (50); Chloral (60); 
Cyan (66); Grindelia (72); Lactucar. (74); Lobelia (75); 
Colch. (105); Bell. (p. 24); Cannab. (p. 28); Gels. (p. 33); 
Ipecac, (pp. 82 & 100); Jod. (pp. 14 & 15); Conium or 
Stramon. hypod.,(248 &9); etc. If bronchitis present, 
Arsenic per os, hypodermically, or inhaled (pp. 9, 107 & 
120). In A. pituitosum, Apomorphina (96). In hay- 
fever, if catarrh predominates, Cocaine (285). 

Astigmatismtts. See Eye (Vision). 

Ataxia locomotor {Tabes dorsualis) — Unsteady and 
disordered movements of the extremities on account of 
impairment or loss of the ability to combine and direct 
muscular movements by the will, and dependent chiefly 
on sclerosis of the posterior columns of the spinal cord. 
Treatment — Aurum (p. 10); Argentum (p. 74); Phosphor, 
Zinc (pp. 85 & 87); or dry stimulation, see Electricity, 
page 149; eventually an antisyphilitic treatment. 

Atelectasis (Apneumatosis) — Collapse of pulmonary 
lobules. See Broncho-pneumonitis. Congenital atelect- 
asis in the newly-born is characterized by rapid and 



Bladder. 169 

weak breathing, a feeble cry and cyanosis. See Asphyxia. 

Atresia Ani et Vaginae. See Anus, resp. Vagina. 

Atrophy. Progressive muscular ( Wasting or Creep- 
ing Palsy) — A spinal amyotrophic affection, character- 
ized by a wasting of some muscles, whilst adjacent ones 
remain intact, thus producing many deformities. The 
claw-like hand — la main en griffe — due to paralysis of 
the interossei, is a frequent, and therefore characteristic 
deformity. Treatment — Next to a judicious diet, Potass 
(31); Calomel (pp. 92 & 93); stimulating embrocations 
(409 & 11), and electricity (p. 148). 

Balanitis. See Gonorrhoea externa. 

Baldness (Calvities) and Barber's Itch [Tinea Sy- 
cosis). See Head. 

Barreness. See Sterility. 

Basedow's disease. See Bronchocele. 

Basilar Meningitis. See Meningitis (tubercular). 

Bedsores. See Decubitus. 

Biliousness. See Dyspepsy (acute). 

Bites and Stings of insects, etc., maybe treated with 
Caustic, Ammonia (407), etc.; of poisonous snakes, Alco- 
hol, Ammonii Carbonas (pp. 72 & 73). See page 6. 

Bladder — Irritable bladder, unless due to inflamma. 
tion or organic disease, may be caused by irritation of 
adjacent organs; an irritating state of urine; nervous- 
ness (as not uncommon in elderly people); general 
debility, and cold. It is characterized by frequent in- 
clination to pass water with or without spasm. Treatment 
—Above all, removal of cause, as piles, ascarides, etc. 
Attention should be paid to the urethra, as stricture will 
produce occasionally a form of incontinence, which is 
amenable to cure only by the sound. Soothing medi- 



1*70 Bladder. 

oines, as Bell. (p. 24), may be of use in nervous cases. 
In cases with alkaline urine, mineral acids (152 & 153); 
for debility, Nux Vomica and Ferrum (pp. 19 & 83), etc. 
Enuresis JVocturna(NaechtlichesjBettnaessen)- Nocturnal 
incontinence, which arises from such causes as enumer- 
ated, and which is common in delicate children, is to be 
treated on the same principles. Aside from the remedies 
mentioned, Ferr.jod. (p. 15), may be tried, or Capse/la 
(p. 134). If from irritating urine, Chloral (p. 30), etc., 
and perhaps a blister (408), to sacrum; if the urine is 
not irritating, Canth. (p. 47), in minute doses. If there 
be hyperesthesia of the organ, the child should be made 
to sleep on its side, so that the urine may not be kept 
upon the over-sensitive surface of the trigone. 

Cystitis — Catarrhal inflammation of the mucous mem- 
brane lining the bladder is generally a consequence of 
irritation — ill-treated gonorrhoea, gout, stone, etc. It 
is characteiized by severe pain about the perineum, 
groins and sacrum; frequent micturition, with tenesmus 
— sometimes retention of urine — and fever. The urine 
at first bloody, contains afterward mucus or a muco- 
purulent sediment. Treatment — Fomentations and, if 
necessary, leeches with Calomel (p. 92), or Nitre (122), 
or alkalies (pp. 53 & 93). To relieve pain and tenes- 
mus, Opium per os, per anura or hypod. (pp. 56, 110, 135 
& 36); Bell., Chloral, Hyoscyamus, etc. (pp. 24, 30 & 33). 
In the chronic form, which is mostly a consequence of 
irritation from stone (see Calculi), diseased prostate, 
stricture, or gout, there is less pain and no fever; but the 
urine is, as a rule, alkaline, and sometimes so viscid as to 
cause retention by blocking the urethra. Treatment — 
Removal of cause as far as possible. For pain, Opium 



Bladder. 171 

supposit. (375); in strangury, Brom, Camphora, Canna- 
bis (PP- 2 ^ & 28). Of special value are, barring Pareira 
(114), Arctostaphyl. and Buchu, or Chian turpentine (101 
& 151); Benzoin, Lith. and Copaiva (98, 106 & 110) are 
also much employed. Lycopod. (76) is occasionally of 
use. If the urine is very ammoniacal, warm water, pure 
or acidulated with Acid, nitric, injected by means of a 
catheter with double passage, is highly useful. Resorcin 
(335) is likewise recommended. 

Paralysis Vesicae — If the Detrusor itrinae alone is 
paralyzed, there will be retention of urine {Ischuria 
paralytica)', if the Sphincter vesicae, incontinence (En- 
uresis paralytica). In the first case there is complete anaes- 
thesia, the patient not feeling the want of emptying the 
bladder, which will be seen as a hard rounded tumor, 
reaching sometimes nearly to the navel; in the latter,* 
the water is dribbling away; though mostly both, in- 
continence and dribbling, exist, not because the water 
cannot be retained, but because it cannot be voided: the 
bladder will never be quite empty. Paralysis, unless 
due to injuries or disease of the head or spine, opera- 
tions about the perineum, etc., is generally a consequence 
of prostatic disease or stricture (see these affections); 
but it may also occur to nervous people, who allow the 
bladder to become over-distended. Treatment — In re- 
tention, or when, in spite of incontinence, the bladder 
is found distended, the catheter (330), is required. 
In pure palsy Ergot and Ferrum (pp. 6b & 67), will 
generally meet the case; Strychnine or Cantharides (pp. 
83 & 75), are sometimes of service; also Buchu or 
Arctostaphy/um; sometimes Benzoin (p. 46), Cubebce, or 
electricity from the pubes to the sacrum. Dribbling in 



172 Bladder. 

old people is occasionally benefited by Erigeron or 
Rhus (141 & 149). 

Spasmus Vesicae (Cystospasmus) — If the Detrusor 
alone is affected, there will be continued dribbling of 
urine [Enuresis spastica); if the Sphincter ', either com- 
plete retention [Ischuria spastica) or difficult micturi- 
tion (Dysuria spastica) ; and if both muscles are impli- 
cated, there will be tenesmus with retention. Cramp of 
the bladder is sometimes caused by irritation of adjacent 
organs, but generally it is due to nervous excitement — 
fright, etc.— -and cold. The fits, which usually last but 
a few minutes — at the end of which a great quantity of 
urine may be passed — are characterized by an excruciat- 
ing pain about the perineum, shooting toward the 
point of the urethra and testicles, followed often by 
vomiting, sometimes by syncope. Treatment — Fomen- 
tations to the perineum, or a warm bath — a cold douche 
against the perineum will frequently cut the fit — in con- 
junction with sedatives— Camphora, Hyoscyamus, Lupul., 
Lycopod., etc. ( 54 & 76). Retention of urine, caused by 
spasmodic stricture, requires, if the symptoms be urgent, 
the catheter under Chloroform or with Cocaine (330). 
[Retention should not be confounded with suppression 
— see Ischuria renalis]. Hot applications and a little 
Chloroform or Dover's powder (79), followed, if necessary, 
by Castor oil, will frequently suffice; sometimes Soda 
(p. 55) is of benefit; or & suppository (375); Tinct.Ferri 
chlor., 10 drops about every ten minutes, acts often like 
a charm, if the spasm arises from dietetic errors. If pro- 
duced by cantharides, Camph. with Hyoscyam.; and in 
case of inflammation of the urethra, leeches must be 
applied. Sometimes aspiration (p. 123) is the only 



Bladder. 173 

remedy left. In hysterical retention, where it is due to 
want of will rather than to want of power, one introduc- 
tion of the catheter effects often the cure; else an anti- 
hysterical treatment — Pulsatilla (p. 16), etc., would be 
indicated. Retention from pressure of the prolapsed 
uterus on the neck of the bladder, or of the gravid 
uterus during the last months of pregnancy, requires 
catheterization (p. 125). Retention of urine in infants 
is generally relieved by Hyoscyamus or Spir. nitrico- 
cethereus (p. 33). For treatment of Hoematuria see 
Hemorrhage from the bladder. 

Prolapsus Vesicae — Barring a frequent desire to pass 
water, especially at night, prolapse is characterized by a 
dragging pain about the umbilicus. This pain, which is 
also a symptom of procidentia uteri, and which is worse 
before micturition, depends on the tension of the super- 
lor ligament of the bladder (formed by the remains of 
the two umbilical arteries), which passes from the fun- 
dus of this organ to the navel. After having passed a 
catheter into the bladder, the instrument may, by rais- 
ing its free extremity, be pushed oictivard and downward, 
so that its point can be felt against the protruding 
bladder. Treatment — Aside from the regulation of 
bowels, the restoration of the organ to its position, and 
keeping it in situ by means of an india-rubber ball or a 
sponge, an astringent wash (359 & 61) should be injected 
twice daily into the vagina, whilst a catheter is con- 
stantly kept in the bladder. 

Bleeding Wounds. See Hemorrhage. 

Blennorrhoea. See Vaginitis. 

Blepharism. See Eye (Lids). 

Boil. See Furuncle. 



174 Brain. 

Brain — Anaemia — K deficiency of blood in the brain, 
due to congestion of other organs, vasomotor spasms, 
heart disease, and above all, to much loss of blood. If the 
hemorrhage is sudden, there will be fainting. Chronic 
anaemia is, aside from occasional faints, fits of vertigo 
and blindness, characterized by a weak pulse, pain in 
the forehead, tinnitus aurium, sleeplessness and frequent 
dreams. Treatment according to cause. Zinc and Phos- 
phor (pp. 85 & 86) are good tonics. During the fit, 6ra/7(//, 
Camphora, Valeriana (pp. 27 & 28), etc. See Syncope. 

Hypevaemia — A congestion of the brain, active or 
passive — the former, consisting in an excess of arterial 
blood, is due to the increased force of the heart's action, 
paralysis of vasomotor nerves, etc.; the latter an excess 
of venous blood, produced by an impediment to the re- 
turn of blood from the head, as pressure of the jugularis 
in goitre; of the vena cava by aneurism, and other 
tumors, etc. The acute form is characterized by head- 
ache, with a sense of fullness or weight and heat; flushed 
face, intolerance of light or scintillations; vertigo, tin- 
nitus aurium, and sleeplessness. In more severe cases 
there w T ill be strong pulsation of the carotids, mental 
confusion, delirium or convulsions. [In apoplexy from 
oerebral hemorrhage or embolism there is hemiplegic 
paralysis]. Treatment similar to that of apoplexy. Dry 
cups to neck; stimulating pediluvia (419); Brom, Chloral, 
Gelsemium (pp. 27 &33); or Ergot (pp. 65 & 78); after- 
ward salines or Colchicum (pp. 48, 90 & 96), with regula- 
tion of diet. In the passive form, which is characterized 
by more or less cyanosis, turgid veins of the head, 
somnolency and dullness of mind, the obstruction must 
be removed as far as possible. 



Brain. 175 

Encephalitis — Inflammation of the substance of the 
brain is always limited, the foci varying in size from a 
pea to a walnut, and eventuating either in softening and 
abscess, or sclerosis. The former, unless traumatic, is 
generally a sequel to caries from disease of the ear, nose, 
or orbit, etc. Acute Cerebritis may begin with an apo- 
plectic fit, which, however, will have been preceded by 
mental aberrations for sometime; sudden and complete 
hemiplegia; or simply with a stage of irritation. (See 
Meningitis). If chronic, it is like induration, attended 
by cephalalgia, vertigo, vomiting and tremor, in conjunc- 
tion with mental dullness, failure of memory, and some- 
times aphasia — the latter if the morbid change is in the 
left anterior lobe of the cerebrum, near the island of 
Reil. Pathognomic of sclerosis are successive psralytical 
manifestations of an hemiplegic nature, according to the 
seat of the lesion, and the jog-trot gait {.festination) of 
the patient, whose body, when standing, appears more 
or less stooped. Treatment of acute encephalitis re- 
quires the remedies indicated in hyperemia: Cold to 
head; blisters to scalp, and cathartics, according to the 
severity of the case. In the chronic form, next to rest 
of body and mind, tonics with mild revulsives — Brom, 
Chloral, Phosphor, etc., according to circumstances. In 
sclerosis (a hyperplasia of the neuroglia, the analogon of 
the connective tissue in other situations), which may 
affect an entire hemisphere: Barium (5); Phosphor (154 
& 194); Sublimate (p. 13), etc. 

Tumors within the cranium will, aside from their 
quality and situation — which may produce special effects 
— sooner or later occasion symptoms dependent on soft- 
ening, inasmuch by pressure they either excite cerebritis, 



11 6 Brain. 

thereby inducing softening; or interfere with nutrition, 
thus leading to non- inflammatory softening. Both kinds 
are generally followed by hemorrhagic extravasations. 
( Softening from suspended nutrition — necrobiosis — is 
also caused by embolism, thrombosis, atheroma, etc., and 
can therefore not be treated as a special disease). Treat- 
ment — Arsenic, Mercury and Jodine (pp. 9, 13 & 14), may 
be tried, even if the tumor be non-syphilitic. 

The diagnosis of locating a disease within the cranium, 
has its difficulties. Thus, lesions of the cerebellum may 
remain entirely latent, though, as a rule there are dis- 
turbances of co-ordination {cerebellar ataxia, and dizzi- 
ness, which may be superadded by vomiting and ambly- 
opia.; even amaurosis may result. Lesions of the pons 
Varolii- — especially hemorrhage — may be diagnosticated, 
if there exists crossed paralysis: Facial on one side, and 
paralysis of the extremitiescon the other. Lesions of 
the medulla oblongata are the only central lesions, which 
can cause aphonia — see Paralysis (bulbar). Hemorrhage 
into the medulla proves fatal, either instantaneously or 
within a few hours. Lesions of the cms cerebri produce 
a crossed paralysis: On the one side of the ocidomotorii/s, 
characterized by ptosis, dilatation of pupil, external 
strabismus, combined sometimes with double vision, and 
vertigo; on the other side there is loss of motion or 
hemianesthesia. Lesions of the corpora quadrigemina 
lead always to blindness. Characteristic of lesions of 
the motor cortical zone — the anterior and posterior cent- 
ral convolutions with the paracentral lobules — are the 
localized paralyses known as monoplegia and dissociated 
hemiplegia, etc., etc. 

Breajk>bone fever. See Scarlatina rheumatica. 



Breast. 177 

Breast — Mastitis — Inflammation of the breast should 
be treated with fomentations and poultices; or, if very 
severe and the pulse good, a purgative or leeches. As 
soon as suppuration is evident, an incision, radiating 
from the nipple (to avoid cutting the lactiferous ducts, 
as far as possible) must be made; and a small tent of 
lint may be inserted between the lips of the opening, 
which should be removed several times a day, whilst the 
fomentations are continued. When the inflammation 
has subsided, antiseptic dressings may be employed, 
after having supported the breast properly by straps of 
adhesive plaster — see Abscess. Tonics (166) to invigor- 
ate the system will generally be found useful. 

In simple engorgement the application of the infant 
or of a pup will suffice to remove distension and prevent 
an abscess. If the nipple is so flattened that the child 
cannot grasp it, an empty, previously with hot water 
heated bottle, may be turned over it, and the nipple will 
elongate, whilst the milk is spurting out. If the milk 
should be too abundant, solid food in conjunction with 
salines (p. 96) to keep the bowels open, will be indicated. 
Engorgement after weaning, or when there is already 
pain, demands at the same time Antimony (p. 23); Pulv. 
Doveri (pp. 37 & 38), and locally Oleum Camphorce. 

In cases, where after delivery the secretion of milk is 
tardy, plenty of gruel is the remedy. A poultice of FoL 
Ricini to breast, and steam of a decoction of same to 
vulva are sometimes used — the latter, by making the 
patient sit over it, ricinus being supposed to be both 
emmenagogue and galactogogue. 

Sore Nipples may be washed with brandy and water, 
each time, after the child has been removed. If they 



178 Breast, 

are very sore, Tannin or Cocaine (396 & 415), etc., etc. 
(Sore nipples may be altogether avoided by washing 
them with cold w T ater, and pulling at them daily for 
several months before confinement. 

Mastod/ynia — Neuralgia of the breast is characterized 
by an excessive sensibility or piercing pain in the breast, 
passing on to the shoulder, sometimes to the elbow and 
even fingers. It is generally associated with undue irri- 
tability of the constitution, especially an abnormal state 
of the menstruation; and frequently accompanied by an 
irritable tumor, sometimes not larger than a j>e&, movable, 
and often very sensitive, which may be discriminated 
from scirrhus, by the latter being of great hardness, the 
skin, covering it, becoming adherent and of a tubercul- 
ated character; whilst the pain, though lancinating, is 
usually limited to the breast. Treatment must be anti- 
neuralgic, with attention to the general state of health 
(p. 91). See Neuralgia. 

Breath, Foul. See Mouth. 

Bright's Disease. See Kidney (Nephritis). 

Bronchitis {Cold in the chest) — An inflammation of 
the large bronchial tubes, with or without fever, mostly 
preceded by a catarrh of the nose and upper air pas- 
sages; and unless a complication of other diseases, as 
measles, variola, typhus, emphysem, etc., due to cold or 
an atmospheric influence of some kind — see Catarrh. 
Bronchitis is characterized by an obtuse, substernal pain, 
together with a peculiar sore or raw feeling, especially 
on coughing. Dry or moist rSles are generally present; 
but the results of percussion are negative. Treatment — 
Pu/vis Doveri (79) at night, followed by stiff grog and a 
pediluvium, at the commencement will generally cut the 



Bronchitis. 179 

disease. Quinine and Salicin (pp. 11 & 18) are said to 
abort the disease too. Locally, Mustard or some stimu- 
lating liniment (409); but no blister. Nor should ex- 
pectorants be given in the first stage, as they tend only 
to increase the inflammation; but water may be kept 
boiling on a stove, as the inhalation of steam will always 
afford relief. At the same time one of the following 
remedies is sure to meet the case: Ammonium or Apomorph, 
(94 & 96); Potass. (119 & 122); Veratrum (84); Opium 
1 7 8 & 113) — this is contra-indicated if the efforts of 
expectoration are inadequate to prevent the accumula- 
tion in the bronchi, in which case Potassii Jod/dum. If 
feverishness, Aconite or Antimony (pp. 22 & 23). In a 
child, occasionally a mild emetic (p. 101). 

The chronic form, unless associated with emphysem, 
tuberculosis or cardiac disease, involves the same causes 
as the acute; often it depends on climatic causes, occur- 
ring every winter, to disappear again in the warm season. 
Treatment — Most remedies employed in acute catarrh; 
though Pot. Jod. (p. 14 & 15) is perhaps the most reli- 
able. Copaiva (pp. 48 & 49) is sometimes of value; and 
a glass of S el terser with hot milk every morning is of 
great benefit in cases of old standing, especially in con- 
junction with tonics (pp. 75 & 76). If cough trouble- 
some, Cyan (67) or Opium — see Cough. In hypertrophy 
of the mucosa ( Bronchoblennorrhcea or Phthisis pituitosd) , 
characterized by abundant expectoration, sometimes 
fetid, and easily brought up, antiseptic inhalations (302, 
324 & 334). If emphysem {Catarrhus siccus), charac- 
terized by wheezing, shortness of breath and asthmatic 
paroxysms, inhalations of tablesalt, Ammonia or Iodine 
(306 & 321); Arsenic (pp. 9 & 120), is occasionally the 



180 Bronchitis. 

remedy. If atrophy {Bronchorrhoea serosa), combined 
with asthma or valv. lesions, and characterized by short 
breath and abundant watery expectoration, especially in 
the morning, Tannin, Creosot, Uva Ursi or Tar (pp. 52 
to68); wiihastr/ngent or soothing inhalations (3 15 & 323). 
For HJpidemic Bronchitis see Influenza. 

Bronchitis oapillaris — An extension of the inflam- 
mation of the larger bronchi to the smaller tubes — very 
liable in children and old people. This affection never 
gives rise to acute lobar pneumonitis, though there may 
supervene inflammation and collapse of pulmonary lobu- 
les in consequence of the accumulation of mucus, con- 
stituting broncho-pneumonitis. It is attended by accele- 
rated breathing with dilatation of the aloe nasi {Nasen- 
fluegelathmeit), dyspnoea, more or less lividity, an extreme- 
ly painful cough, short and jerking speech, etc. The 
disease being bilateral, moist rales, coarse, fine and finest 
(subcrepitant) — gross t klein und mittelblasiges Basseln — 
according to the size of the tubes, exist on both sides, 
and may be heard best at the back. Diagnostic are the 
sputa, which, consisting of mucus from both the larger 
and smaller bronchi, will float on water, the mucus of 
the latter, on account of its greater specific gravity — not 
being mixed with air, like the former — hanging rope- 
like into it. A rise of temperature to 103 or 104 de- 
grees and dull percussion are signs of complications — 
see Broncho-pneumonitis. Treatment as indicated for 
bronchitis of the larger tubes; especially inhalation of 
warm vapor by keeping the atmosphere of the room 
charged with steam. To excite deep inspirations and 
prevent atelectasis the child may have cold affusions 
directed toward the nuca, after having been placed in 



Bronchocele. 181 

a warm baih. I use, whenever practicable, the wet pack 
(420), with Priesnitz' compress (298). A nutritious diet 
with brandy (f 3), and to/7 /cs are of the greatest importance. 

BR0NCH0-PNEUM0XITIs(^071cA0J^n6l/7?^7?iaik/an^/r>l) 

— Lobular Pneumonitis is a lobular inflammation of the 
lung tissue, superadded to the bronchial affection, and 
incident chiefly to childhood. Being characterized by 
the symptoms of bronchitis capillaris, it cannot be differ- 
entiated from it, unless a high temperature, but above 
all, dullness can be demonstrated — a vesiculotympanitic 
sound on percussion at the upper lobes indicates emphy- 
sematous lobules. As the pyrexia is proportionate to 
the acuteness of the bronchial inflammation and to the 
extent of lung involved, the affection, which will also 
occur in the course of pertussis, and be a sequel of other 
diseases, especially of eruptive fevers, may «be of great 
severity, or comparatively devoid of danger. In very 
young children it is usually preceded and accompanied 
by ^pneumatosis. The most frequent termination of 
the lobular inflammation is as in lobar pneumonitis in 
resolution, the inflammatory product undergoing fatty 
degeneration, which, after having been emulsified with 
the transuded serum, is absorbed. The caseous meta- 
morphosis leads to the development of phthisis. Treat- 
ment is that of bronch. capill., as there are no other means 
but the cold affusions for the prevention of atelectasis. 

Bronchocele (^Basedoitfs Disease — Hypertrophy of 
thyroid Body and Prominence of the Eyeballs) — Exoph- 
thalmic Goitre is associated with functional disease of 
the heart, throbbing of the arteries, loud whirring — 
ancemic purr — during the systole, and in the arteries 
and veins; and consequent great nervous excitement. 



182 Bubo. 

Treatment should be anti-hysterical — Valeriana & Ferrum 
(pp. 29 & 79); Brom or Con/urn (pp. 24 & 31); Barium 
or «/otf (pp, 10 & 14); with purgatives (p. 89); or Aconite 
(p. 22). Locally, «/o</ (20), or Phenol as injection (372 
& 398). If apoplexy or suffocation is threatening, the 
seton, electrolysis (p. 149), or the knife. 

Bubo — An inflammatory swelling of a lymphatic 
gland, especially in the groin, due to some kind of irri- 
tation; but usually in connection with a venereal sore or 
gonorrhoea. Treatment like that of abscess. After in- 
flammation has .subsided the tumor will often disperse 
by painting it with Iodine (20 & 402); pressure by means 
of a pad and bandage, event, cold water compresses, in 
conjunction with purgatives (219). If, however, the skin 
becomes thin and shining, a free and vertical incision 
should be 'made to prevent pocketing of the matter. If 
the bubo be specific, an anti-syphilitio treatment is indi- 
cated — see Syphilis. The indolent bubo, when followed 
by infiltration and threatening abscess, requires tonics 
(p. 76), with Iodine or small blisters (408) locally. 

Burns and Scalds. See Combustio. 

Cachexia. Malarial — A depraved state of the sys- 
tem due to slow but continued absorption of malaria 
poison, or following protracted cases of intermittens. 
The peculiar hydrsemic condition is characterized prin- 
cipally by an enlargement of the spleen (ague cake), 
and a sallow, more or less cedematous face. Quinine is 
the remedy (pp. 11 & 75). See Fever (Intermittens). 

Calculi. Biliary— Stone-like concretions in the gall- 
bladder. See Colic (hepatic). 

Calculi, renal — Stones in the kidney are usually 
composed of lit hie acid, known by the deposit of red 



Calculi . 183 

sand from the urine; calculi of oxalate of lime are less 
common; and phosphatic stone, which indicates incipient 
disease of the organ, is still more rare. The presence 
of stone is characterized by pain in one or both loins, 
irritation and retraction of the testicles; occasional in- 
flammation of the organ, and sometimes bloody urine. 
Treatment — Next to diluents and diuretics, as Vichy water 
and Potassium (pp. 53 & 6), mild aperients (pp. 96 & 7) > 
and warm enemaia. In case of inflammation, a warm 
bath, fomentations or ice with sedatives (p. 20); if the 
inflammation very severe, leeches or cupping. The pass- 
age of the stone through the ureter causes sudden and 
severe pain in the loins and groin, subsequently in the 
testicles and inside the thigh, with spasmodic contractions 
of the former, accompanied by violent vomiting, faint- 
ness and collapse, and may last from two to three days. 
Treatment consists of plenty of diluents; the warm bath, 
and emollient enemata (386), with large doses of Opium 
and Chloral (pp. 30 & 35), or Chloroform inhalations (304). 
Calculi. Vesical — Stone in the bladder is either from 
the urine or from the mucus of the bladder, dependent 
on prostatic disease; or if foreign bodies are introduced 
into the bladder to serve as nuclei, in which case they 
consist of phosphates. The symptoms are: Irritability 
of the bladder, with frequent desire to make water; 
occasional sudden stoppage of the stream; occasional 
passage of blood; occasional pain at the neck of the 
bladder, always most severe after micturition; and a pain 
in the glans penis. Sooner or later the urine becomes 
alkaline, and loaded with viscid mucus and phosphate of 
lime. Treatment — After the existence of the stone has 
been ascertained by means of a sound, litholysis: Acid. 



184 Carbuncle. 

nitric, d. injected as in chronic cystitis, will reduce the 
size of phosphatic calculi, or dissolve them sometimes 
altogether. The continued use of Vichy water, or a solu- 
tion of Sodii Bicarbonas, saturated with carbonic acid, 
will also disintegrate lithic calculi. See Urinary De- 
posits. In obstinate cases recourse must be taken to 
/ithotrity or /it ho to my. 

Calvities (Baldness). See Head. 

Cancer. See Carcinoma. 

Cancrum Oris (Stomatitis gangrenosa). See Mouth. 

Carbuncle (Anthrax) — An exaggerated boil of a gan- 
grenous nature, sometimes attended with fever, and 
always dependent on a vitiated state of the blood. 
Treatment — Fomentations and a brisk purgative (p. 92). 
Afterward Ungt. Belladonnas or Phonol-lod (400 & 402), 
if very painful; or Iodine (20) to produce vesication; and 
if necessary, free radiating incisions at early stage. In- 
ternally, sulfides (pp. 18 & 19); Opium (p. 35), and tonics 
(pp. 71 & 76), in conjunction with a generous diet, in- 
cluding wine and brandy. See Abscess. For Carbuncle 
of genitals see Vulva (Vulvitis gangrenosa). 

Carcinoma — A peculiar malignant growth, making 
constant progress, destroying and causing absorption of 
the invaded tissue, tending towards suppuration and 
infection of the lymphatic glands, thus reproducing itself 
at distant parts, and even recurring after extirpation. 
Cancerous tumors are characterized by a stony hardness 
and severe pain of an intermittent and neuralgic kind, 
felt in the tumor itself as a sharp stabbing or burning 
sensation, and followed sooner or later by general 
cachectic symptoms. Treatment — Injections of Arg. 
nitr., Phenol and Pepsin (327, 98 & 403), or Ozonewater 



Carcinoma. 185 

(0.1:500.0) may be tried; but if they fail to arrest the 
growth, extirpation before the corresponding lymphatics 
become affected is the safest plan. If not practicable, 
Opium (p. 35) and tonics (p. 76), with Belladonna plaster 
or Chloroform liniment (411), for the relief of the neu- 
ralgia. After ulceration, according to circumstances, 
either soothing applications, Opium (358, 65 & 400); 
Bell., Chloroform, Iodoform (350, 51 & 75); Bism. (351 
& 93), etc.; or stimulating ones — blackwash (4=00); yeast 
poultice; astringents — Tannin, Zinc or Iron (338, 41, 45 
& 77); or antiseptics — Phenol, Creosote (337 & 52), etc. 
A small bag of charcoal, dry and wrapped in flannel, 
may be laid over the wound to absorb the effluvia. 
(Poultices should not be applied too warm for fear of 
excoriating the surrounding skin; though it may be 
remedied by dusting the part with bismuth or tannin. 

Carcinoma Ventriculi — Cancer of the stomach is at- 
tended by pain of a burning and lancinating character, 
which increases upon pressure; by vomiting of sarcina 
and blood; and often by a peculiar green is h-yellow com- 
plexion, the so-called cancerous cachexia. Treatment — 
Above all, a nourishing diet, as eggs, buttermilk, etc.; 
if necessary, Pepton (p. 84) and rectai alimentation (387). 
Cathartics should be avoided. If pain or vomiting, 
Arsenic or Bismuth (pp. 10 & 46). Chian Turpentine is 
recommended. (There are four varieties of Carcinoma: 
the medullary, the most malignant and vascular; the 
colloid, which is the least vascular and malignant; the 
epithelial; and scirrhus, which latter is of a stony hard- 
ness, slow growth, and consists principally of a dense 
fibrous tissue). 

Carcinoma Uteri is most frequently medullary cancer, 



186 Carcinoma, 

presenting the features of fungus hcematodes. The 
epithelioma, which attacks the mucous membrane of the 
os, may present itself either in ulceration of this mem- 
brane, or in the development of cauliflower excrescences. 
In the incipient stage, where the only symptom may be 
menorrhagia, the os having a nodulated and hard surface^ 
cauterization with Argentum nitricum or Potassa c. Calce 
at intervals of five or six days, without paying attention 
to the discharge of blood, may avert still the disease, as 
they will improve the condition of those parts and pro- 
mote a slough of the cancerous mass. If, however, more 
advanced — the womb enlarged, immovable, the lips 
everted and ragged with deep ulceration, much hardness 
in the surrounding tissue, the vagina and rectum both 
being involved in the induration, attended by profuse 
loss of blood (see Hemorrhage); mucous, mucopurulent 
or serous, sometimes very fetid discharges; by pains in 
the hips, thighs and uterus; with increased weight, ex- 
treme prostration, frequent vertigo and sick stomach — 
Treatment can be but palliative. Cauterization for temp- 
orary "relief, with Iodine (20); Chrom, Benzol, lUangan 
(402 & 3); Cuprum, Liq. Hydr. nitr. (344 & 47), etc. But 
the speculum must not be unnecessarily introduced, as 
it will aggravate the pain and may cause flooding. To 
alleviate pain, Arsenic, Silicium or Hyoscyamus (pp. 10, 
19 & 27); and locally Opium (365 & 75); Belladonna or 
Chloral (350 & 65); Iodoform and Conium (373 & 75); if 
nothing of avail, /ce'(3l2), or a blister to sacrum, 
dressed with about two grains of Morphia, and repeated 
according to the emergency. In mucous or serous dis- 
charges, Acid, nitric, Alum, Creosote (362 & 63). Consti- 
pation should be relieved by the use of enemata (386). 



Catarrh. 187 

Cardiac Disease. See Heart. 

Cardialgia. See Dyspepsia. 

Caries — Ulceration of the soft part of a bone, de- 
pendent on some constitutional disorder (scrophulosis, 
syphilis, etc.), requires appropriate Treatment of cause, 
and locally injections of Acidum nitricum v. phosphoricum 
dil., after having removed the diseased part by forceps 
or gauge. See Necrosis. 

Carphologia. See Subsultus tendinum. 

Caruncle urethral. See Urethra. 

Catalepsy — A form of hysterical coma, the sensory 
functions, volition and consciousness being suspended; 
with the addition of a peculiar wax-like rigidity of the 
voluntary muscles, retaining the limbs or the different 
parts of the body, in any position, in which they may 
have been placed by the hands of others. Treatment as 
in hysterical coma. If the paroxysm should last for 
weeks or months, forcible alimentation must be resorted 
to; afterward any derangement of the organs of genera- 
tion should be attended to. 

Catarrh or Cold par excellence (Schnupfen) is a 
catarrhal inflammation, which extends over more ox less 
of the mucous membrane that lines the tract, leading 
from the nose to the lungs, its distinctive name being 
derived from the particular part affected, as cold in the 
head, cold in the throat, cold in the chest, etc. Treatment 
as indicated in bronchitis, coryza, pharyngitis, etc — 
Pulsatilla and Antimony (pp. 16 & 23); Ferrum, Cocaine 
or Phenol (285, 89 & 99); Alum, Iodine (299 & 321, etc. 
For Cervical and Intestinal Catarrh see Uterus (En- 
dometritis), resp. Enteritis. 

Cellulitis, periuterine. See Uterus. 



188 Cephalalgia. 

Cephalalgia — Headache is a neuralgic affection, sup- 
posed to depend upon either spasm or paralysis of the 
muscular fibres of the arteries within the skull, which is 
produced by a vaso-motor influence of some toxical 
agent, acting on the sympathetic nerves. Treatment 
according to cause: If from constipation, cathartics 
(p, 88); if congestion, Aconite or Ergot (pp. 22 & 65); 
if syphilitic, Iodine (pp. 14 & 15); if from defective 
menstruation, Brom (50 & 53); Veratrum (p. 39). In sick 
headache, Caffein, Guarana (1*78, 163 & 242); if periodic, 
Sa/icin (29); if throbbing pain in brow, Arsenic (p. 10). 
In migraine, Brom, Caffein, Cyan, Cypripedium {66 & 69); 
Arnica (p. 74); Chloral (pp. 30 & 109); Camphora (54, 
243 & 314); Cannabis (p. 28)-; Valeriana or Zine (193 
& 96); Chloroform or Amyl (37, 246 & 308); Aconite or 
Veratrum externally (410), etc. See Neuralgia (trifacial). 

Cephalhematoma — A tumor consisting of an extra- 
vasation of blood under the scalp, caused by pressure on 
the head during parturition, which is soft, painless and 
slightly compressible. Treatment— Evaporating lotions 
and gentle pressure by the cross-wise application of 
strips of Emplastrum adhcesivum, to assist absorption. 

Cerebral Disease. See Brain. 

Cerebro spinal Meningitis. See Meningitis. 

Cervicodynia. See Myalgia. 

Cervix Uteri. See Uterus. 

Cessation of Menses. See Menopause. 

Chancre. See Syphilis. 

Chancroid — Soft chancre is a highly contagious, 
suppurating ulcer of venereal origin; and though, when- 
ever oculated, it may be followed by suppuration of the 
nearest lymphatic gland (see Bubo); it is but a local 



Cholera. 189 

disease, independent of syphilis, and, therefore, without 
secondary symptoms, which, however, does not exclude 
the co-existence of a chancre. Treatment — If the sore 
should not be a week old, it may be cauterized with 
Acidum nitricum (329); if older, Mercury (347). Other 
applications are: Cuprum, Mangan, Tannin, Phenol (327 
& 340); Iodoform, Jodol or Ferrum (269 & 331). The 
latter three are of special benefit in phagedena. If 
syphilis is suspected, Mercury and Iodine (pp. 13 & 15). 

Chicken-pox ( Varicelli). See Eruptive fevers. 

Chilblains. See Perniones. 

Chlorosis — Green Sickness is a neuropathic affection, 
occurring in girls at or near the period of puberty, and 
dependent on an anaemic state of the blood in conjunc- 
tion with a faulty evolution of the sexual organs. It is 
generally characterized by a greenish complexion and 
perversion of appetite, as a craving for chalk, slate and 
the like. See Anaemia. Treatment — Aside from a gen- 
erous diet with out-of-door life and mental hygiene 
according to indications: Pancreatin, Aloes, Calomel 
(185, 97 & 208); Ferrum and Quinine (166, 75 & 253); 
Acidum su/furicum (129 & 55); lod and Strychnine (pp. 
15, 82 & 83); Arsenic (p. 10); Cocaine (168 & 247), etc. 
Artificial suppression of the menses for a few times by 
injections of cold or warm water, with absolute rest in 
bed, has been recommended in cases where hysteria 
is a prominent symptom. 

Cholera morbus (Cholera nostras) — Sporadic cholera 
is a functional affection of the alimentary canal, pro- 
duced mostly by indigestion. Its chief characteristics 
are : Violerit vomiting, speedily followed by purging, and 
accompanied by colic pains, anxiety, restlessness and 



190 Cholera. 

exhaustion. In severe cases there may be aphonia? 
cramps of the legs, etc.; but the attacks seldom prove 
fatal. Generally the various symptoms soon diminish, 
and after a few hours disappear altogether, even without 
remedial interference. Treatment— Opium (77,255 & 381); 
Brom or Camp ho ra (pp. 27 & 28); Ipecacuanha (p. 100), 
if necessary. A small piece of ice or a tablespoonfid of 
water and no more may be allowed at short intervals, to 
appease a little the intense thirst. Brandy (p. 73), if 
much prostration. Of other remedies may be mentioned 
Chloroform (p. 31); Veratrum, Phenol (22, 84 & 382), etc. 

Cholera Infantum [Summer Complaint) — This name 
embraces different distinct affections, occurring in child- 
ren under two years of age during the hot season, especi- 
ally from June to September: Sporadic cholera, diar- 
rhoea from indigestion, enteritis, colo- enteritis and dysen- 
tery. See these. The development of hydrocephaloid 
during any of these affections is, at least to the young 
child, almost always fatal. Treatment — Bismuth, Creta, 
Catechu (99, 107 & 135); Cinchonidin, Brom or Chloro- 
form (pp. 12, 27 & 31); Camphora, Opium (55 & 77); 
Argenium, Cotoin, Pepsin (133, 37 & 87); Phenol as enema 
(382). Sometimes an emetic is required (p. 100). If 
much thirst, Nitre (p. 57); if much prostration, brandy 
(p. 73); if vomiting, Creosote (138) and Mustard to 
epigastrium, etc. 

Cholera Asiatica — Epidemic cholera is a miasmatic 
contagious disease of the alimentary canal, dependent on 
some specific germ, which finds its way into it, and pre- 
ceded generally by a simple diarrhoea. It is characterized 
by violent purging — copious liquid discharges, the so- 
called rice-water stools — and vomiting, conjoined with 






Chorea. 191 

great prostration, coolness of skin or cold perspiration, 
and sometimes cramps of the muscles; and, if not arrest- 
ed, followed speedily by collapse — the algid or cyanosed 
stage. Treatment — Prophylactically it will be well to 
avoid over-fatigue and undue excitement from whatever 
source; no unnecessary exposure to night air, and par- 
ticular attention to diet: Lobster, oysters and pork, with 
cabbage, peas and beans, especially green corn, cucum- 
bers, melons and the like, should be banished from the 
table for the time being. Premonitory diarrhoea (which 
is considered by some a salutary process to eliminate 
the poison), unless already of some duration, may some- 
times be stopped by Calomel (208), followed by Castor 
oil; Camphora and Ammonia (bo & 1 5 7), are often of use. 
The best remedy is perhaps Morphium (pp. 37, 38 & 110), 
Phenol (22), and Cocaine (168 & 247) are also recom- 
mended. To control vomiting, ice and brandy (p. 73), 
in collapse the latter per rectum (380), with external 
warmth — blankets, hot stones, etc. Iodine (p. 15) is said 
to promptly check vomiting. To arrest cramp, a warm 
enema of salt (386) is sometimes beneficial. In my 
hands has invariably proved successful the modified pack 
(420), w r ith lemonade: 20 drops of Acidum sulfuricum 
dilutum in sugar water (p. 61), ad libitum. 

Chordee. See Gonorrhoea. 

Chorea — St. Vitus Dance is aneurose, characterized 
by irregular clonic contractions of more or less of the 
voluntary muscles, especially of the face and extremities, 
giving rise to movements which are either involuntary 
or not under the control of the will. Treatment — Next 
to removal of cause, as anaemia, worms, etc., invigorat- 
ing measures in conjunction with tonics — Arsenic alone 



192 Colic. 

(pp. 9 & 107), or if jactitations prevent sleep, combined 
with Chloral (60); Ferrum (167), etc; Argentum and Zinc 
(pp. 74, 86 & 87); Cuprum (170); Strychn. (p. 83); />Ay- 
sostigm (270); Cocaine (p. 109); 4/7/7 (38); 4«a fcetida and 
fltffa (41 & 81); Cimicifuga (104); Aconite and Con turn 
(pp. 22 & 31); 0/e*//w Jecoris (185), etc. 

Clergyman's Sore Throat. SeePharyngitis (chronic). 

Coccyodynia. See Myalgia. 

Coitus. Painful. See Dyspareunia. 

Cold. See Catarrh. 

Colica Intestinalis — An affection of the alimentary 
canal, characterized by paroxysmal spasmodic pains in 
the umbilical region, accompanied occasionally by vomit- 
ing, and dependent on a weak and irritable state of the 
digestive system. Treatment — If from indigestion — cra- 
pulous, Opium (pp. 35 & 38); if from constipation, Brom 
(pp. 24-27); if from hepatic derangement — bilious, 
fomentations, etc.; if tympanitic, Dioscorea, Valeriana, 
VaniI.(10, 82 & 83) ; Opium, Chloroform or Asa fat/da (7 7, 
61 & 41). In children, Aqua Calcis, etc. See Enteralgia. 

Colic. Hepatic — A paroxysm of pain about the 
right hypochondriu.n or epigastrium, often extending 
into the chest and right shoulder, due to the passage of 
a gall-stone. It is always accompanied by vomiting. 
See Calculi. Treatment — For the relief of pain, Morphine 
(77 & 225); Atrop. and Chloroform (241 & 304), with ice 
or fomentations locally; alkalies (pp. 53, 57 & 97). Of 
special benefit are said to be Macis, Oleum Olivarum 
and Oleum Therebinthince (146, 150 & 213). For Renal 
and Urinary-, Saturniiie-(Pamter > s) and Uterine Colic, 
see Calculi, resp. Enteralgia from lead or Dysmenorr- 
hea (obstructive). 



Combustio. 193 

Coma — A lethargic state, lasting from a few hours to 
several days, and dependent among other causes, on 
cerebral congestion and insufficient supply of arterial 
blood to the brain; internal and external toxical agents, 
etc, etc. (It is also a pathological element in some 
neuroses, as hysteria, epilepsy and catalepsy.) Treatment 
— If from cerebral exhaustion, nerve tonics and brandy 
(pp. 70 & 72); if from alcoholism (dead drunk), the 
cold douche. In semi-coma or somnolency, due to ner- 
vous exhaustion, strong coffee. In coma of typhoid, 
sinapism or blister (408) to back of neck. If dependent 
on uraemia, saline hydragogues (p. 96), or Tiglium (225), 
unless contraindicated, in which case Pilocarp. hypod. 
(pp. 50 & 110). In hysterical coma — characterized by 
profound but tranquil sleep, without stertor, the pupils 
readily responding to light — aside from the douche, 
enemata of 01. Tereb. or Asa faet. (385). In unknown 
cases of sudden coma, if uraemia be suspected, though 
there should be no dropsy or other symptoms of it pre- 
sent, a little urine should be drawn off and examined 
with reference to albumen, casts and specific gravity. 

Combustio (Burns and Scalds) — Lesions produced 
by the application of heat have to be treated according 
to the damage done. Cotton to exclude the air; Copaiva, 
Glycerin .Collodion or Cocaine (405 & 15). Avery popular 
application is Aqua Calcis cum Oleo Lini; if extensive, 
Phenol or Iodoform (405); from phosphor, Caustic. Very 
severe burns (of second degree) should, after having been 
bathed with warm turpentine, he dressed with Ungt. 
ResincB or Linim. Therebinth on lint, and the whole cov- 
ered with cotton. The dressing should remain as long 
as possible — any loose portions of it should be replaced by 



194 Constipation. 

fresh ointment, the old having been clipped off — and not 
be removed unless there is profuse discharge or bad 
smell from the wound. Burns in the granulating stage 
may be touched with the alcoholic extract of Quebracho, 
until it forms a scab, under which healing is said to 
rapidly take place. Collapse must be treated with brandy 
and beef tea; pain with Opium (p. 37). Remaining 
ulcers have to be managed according to their nature — 
see Ulcers. Proper attention should be paid to the 
cicatrix, on account of its liability to become excessively 
hard and cartilaginous, and to contract in such a way as 
to occasion most serious deformities. In such cases it 
may be necessary to dissect it up from the parts beneath, 
and then filling up the gap by transplanting a portion of 
sound skin from the neighborhood. 

Condylomata. See Syphilis. 

Confinement. See Labor. 

Congestion of Brain and Uterus. See Brain (Hy, 
peraemia) resp. Uterus (Hyperplasia). 

Conjunctivitis. See Eye. 

Constipation (Costiveness, Obstipation) — A func- 
tional disorder of the large intestine, unless dependent 
on some lesion of the alimentary canal, characterized by 
a faulty defecation, as regards the intervals between the 
single acts, the sufficiency in, and quality of the evacua- 
tions, due partly to a diminished secretion of the bowels, 
partly to an impaired contractile power by distention — 
as in habitual constipation — or to both ; or to mechanical 
obstruction — as in females during gestation, etc. It pro- 
duces generally a feeling of pressure and weight in the 
perineum, combined with flatulency, diarrhoea or colic 
pains; sometimes it gives rise to headache, palpitations 



Convulsions. 1 95 

siid general malaise, and very often it is the cause of 
hemorrhoids. Treatment according to cause. If torpor 
or retained feces, especially in full or gouty habits, Aloes 
and Colchicum (pp. 88-90); Potass. (220); Senna (pp. 
91 & 98). If habitual, Fruit (pp. 88 & 95); Glycerin 
(207); Aloes, c. N. Vom. (199); Podoph. (p. 93); Lobelia 
(p. 34). If urine red, Sod. Phosph. (p. 97); if flatulency, 
Colocynthis (203); if very obstinate, Croton (p. 98), 
or enemata (385); if deficient secretion, Ammon, (223). 
In chronic disease, if weakness or general malaise, 
ionic salines, R h am n us or Rheum (215, 216 & 19), 
etc. For the use of women during pregnancy there 
might, aside from fruit, glycerin, salines, senna and the 
popular castor oil, be enumerated still a host of cathar- 
tics, as Mercury (pp. 92 & 93); Gamboge, Magnesia cum 
Rheo (218), etc., etc., to chose from; but for the welfare 
of the patient it will, as a rule, be better to confine the 
treatment as far as possible to massage and simple ene- 
mata (385), which, in connection with a proper diet, will 
answer in most cases. In order to derive from massage 
the desired effect, the rubbing should be commenced in 
the ileo-ccecal region and follow the course of the colon. 
In habitual constipation of children the operation is best 
performed in the morning. 

Consumption (Phthisis). See Lung. 

Convulsions. Epileptiform — Automatic movements 
of various parts of the body, marked usually by clonic 
spasm, dependent on irritation of the spinal cord from 
a multitude of causes, and occurring frequently in child- 
ren and pregnant women. Treatment — If from uraemia, 
Brom (pp. 25 & 27); Chloral and Chloroform (60, 304 
& 379); or Morph. (255)> until the elimination of urea 



196 Cough. 

by hydragogues or suporifics. See Kidney (Bright's 
Disease). Hysterical convulsions, which are always 
more or less voluntary, require the cold douche or Opium. 
See Hysteria. In Eclampsia Gravidarum et Parturleri- 
tium, Verairum (258), or Conium (248), with ice to head 
if indicated, may be tried, irrespective of the sedatives 
above mentioned. In Eclampsia Infantum, Mercury 
(212), if from teething; Vinegar (376), per rectum, and 
a warm bath. Brom, Chloral or Hyoscyamus (p. 34), may 
be tried; or Vanilin (83). In gastric irritation — worms, 
Santonin (p. 103). If due to suppression of eruption 
in scarlatina, Ammon. Acetas (92); oi Ipecacuanha (p. 82), 
with Mustard bath (419); if from loss of blood or exhaus- 
tion, Opium with brandy (p. 37), or Iodine (p. 15). 

Corn. See Skin. 

Cornea. See Eye. 

Coryza. See Nose. 

Cough — Short, abrupt and sounding expirations, 
forced through a more or less contracted glottis, some- 
times of a purely nervous nature; but generally incident 
to some inflammatory state of one or the other of the 
organs of respiration. The neuropathic affection — tiussis 
hysterica — is characterized by a dry, peculiar, sometimes 
spasmodic sound. Treatment — The remedies are seda- 
tives and expectorants; Ammon., Apomorphine (93 & 96) ; 
Nitre, Scilla (122 & 126); Lactucarium, Opium (74, 78 
& 113); Cyan, Chloral, Cerium (67, 60 & 59); inhalations 
oi Belladonna, Conium and Hyoscyamus (312, 15 & 19); 
or of Tar or Turpentine (323 & 24). In the nervous 
form, Hyoscyam. c. N. V. (183); Ipecac, Colchic, Lobelia 
(181, 105 & 75); if due to anaemia, Ferrum c. Chin.; if 
from gastric irritation caused by worms, Santonin (230). 



Decubitus, 197 

Cramp. See Spasm. 

Craving for Drink. See Alcoholism. 

Croup — Membr. or True, and Spasmodic or False, 
See Larynx (Laryngitis exudativa, respect. Spasmus 
Glottidis). 

Crusta Lactea [Tinea Capitis). See Head. 

Cyanosis. See Dyspnoea. 

Cynanche Maligna. See Diphtheria. 

Cyst. Sebaceous, which consists of an organized 
bag, containing sebaceous matter. Excision (396). For 
Ovarian and Vulvar Cyst, see Ovaries, resp. Vulva. 

Cystitis. See Bladder. 

Cystocele. See Hernia. (Vesico-vaginal). 

Deafness. See Ear. 

Debility — A want of strength, both physically and 
mentally. Treatment — Next to a dietetic regimen, re - 
storatives — if after illness, Acid. sulf. with or without 
Strychn. (152-55 & 184); Few. c. Chin. (166 & 173); 
Bebeer. (161); Pancreatin and Pepton (185, 188 & 38 7), 
etc.; if from excessive loss of blood, Opium in large 
doses. See Hemorrhage (post partum) and Hematocele 
(pelvic). In old persons with troubled breathing and 
loss of memory, Arsenic or Digitalis (pp. 10 & 79) are 
sometimes of use. In drunkards, Ammon. (159). In 
nervous exhaustion, without apparent cause, we may try 
also Phosphor (pp. 85 & 87); or Cocaine and Hex Para- 
guay en sis (pp. 77 & 84). 

Decubitus [Bed-sores) — A gangrenous affection of 
integument covering projecting bony parts, as the sac- 
rum, brim of ileum or great trochanter, and due to 
arrested circulation from pressure during protracted con- 
finement to the bed, especially in tedious and debilitate 



198 Delirium. 

ing diseases, conjoined with want of cleanliness. Treat- 
ment — Next to an occasional change of position to avoid 
continued pressure, washing the back and hips with 
brandy is the best preventive. If there is already a 
prickly sensation (just as lying on crumbs or salt might 
produce)^ the parts may be covered with Emplastrum 
saponatum or Zincum tannicum or Albumen (393). Some- 
times a bread and milk poultice will do good. If there 
are already sores, antiseptic applications. See Gangrene. 

Degeneration. Cervical and of Chorion. See 
Uterus. 

Delirium — An agitated condition of the mind, shown 
by a fitful rambling way of talking and usually sympto- 
matic. Treatment — If dependent on trauma, Brom (pp. 
25-7); Chloral (pp. 30 & 109), or Opium (77, 255 & 381); 
in fevers, Antimony (p. 23), Hyoscyamus, Digitalis (pp. 33 
<fc 50), Brom, etc. Hysterical delirium, which consists 
of wild, excited talking, the mind passing rapidly from 
one object to another, sometimes using very obscene 
language, and generally preceded by convulsions or 
eoma, is most benefited by Asa foetida and Valeriana (pp. 
23 & 29); perhaps Brom, but Opium should be avoided. 
See Hysteria. For Delirium tremens, see Alcoholism. 

Dementia Paralytica. See Paralysis (general). 

Dengue. See Scarlatina rheumatica. 

Dentition — Teething of infants, though a physio- 
logical process, is frequently attended by unpleasant 
symptoms, both local and general. Treatment — In 
irritability of the gums with febrile excitement, Aconite 
(35),with perhaps Sodii Phosphas or Mercury (212 & 222). 
Cinchonidin (8), or Cocaine locally (285), are much recom- 
mended. If the gums are swelled, inflamed and tender, 



Diabetes. 199 

whether or not a tooth is ready to come through, a free 
incision may be made with a fine lancet, for the purpose 
of letting blood flow. But if it is tightly stretched over 
a tooth which is bursting through, the incision should 
be carried down to and all along the tooth, so as to 
relieve it entirely. A sharp-pointed instrument should 
be used, to be thrust in with its back to the tooth, and 
made to cut its way out. 

Dermatomycosis [Pityriasis versicolor). See Skin. 

Diabetes Insipidus — Aneuropathic disease,consisting 
of a morbid increase of urine, the specific gravity of which 
is little above that of water, and dependent probably on 
the dilatation of the renal capillaries from influences 
exerted through the vaso-motor system. Polyuria or 
hydruria is however sometimes symptomatic of asthma, 
hysteria and other nervous disorders; in affections of 
the brain, as well as in some kidney diseases, especially 
the small granular kidney, it is by no means uncommon. 
Diabetes is chiefly characterized by constant dryness of 
the tongue and fauces; an excessive thirst [polydipsia) ; 
the patient drinking sometimes several gallons of water 
during the twenty-four hours; and more or less sleep- 
lessness. Treatment — Acidum gai Ileum and Ergot (pp. 61 
& 65) are the remedies most employed; Valeriana (pp. 
29 & 38) is sometimes of benefit; Salicin and Rhus (pp. 
18 & 67) are also recommended. 

Diabetes Mellittjs — A constitutional disease pro- 
duced through errors of assimilation, sometimes due to 
injury of the head and spine, or even violent emotions. 
It is associated with progressive emaciation in spite of 
the frequent presence of polyphagia; but its chief char- 
acteristic is the excessive discharge of urine, which 



200 Diarrhoea. 

contains more or less sugar (glycose), and effect of the 
<jo existing glycohaemia. Treatment — Of most import- 
ance is the diet, inasmuch as amylaceous and saccharine 
food should be altogether avoided; a minimum of bread 
may be allowed, but sugar should be replaced by Glycerin 
(pp. 81 & 89). The remedies most employed are Acid, 
gallic. Creosote (pp. 61 & 64); Ammonia or Soda (pp. 44 
■& 55); Arson, (pp. 9 & 10); Silic. (32); Lith. (110); Brom 
and Bell. (pp. 23-27); or Strychn. zn&Phosph. (pp.82-87). 
Codein (p. 38) diminishes the quantity of glucose; and 
sulfites (pp.18 & 19) have occasion ally a curative effect. 
Diarrhcea — An individual functional disease, char- 
acterized by a morbid frequency of intestinal dejections, 
which in themselves are changed from the normal, quan- 
titatively and qualitatively, if not an element of other 
functional affections, as dyspepsia, cholera, etc. In 
dysentery, typhoid and similar diseases, it is dependent 
on structural lesions; and the colliquative form, if 
persisting or frequently recurring, accompanied by cough, 
will probably be a tuberculous affection of the intestinal 
canal, secondary to phthisis, the existence of which can 
eas : ly be ascertained. Treatment — Diarrhoea caused 
by indigestion, requires a cathartic (p. 88); if due to 
acidity, alkalies (pp. 53 & 54). Creta (p. 49) and 
Magnes. (pp. 51 & 95). In relaxation without inflamma- 
tion, tonic aperients (pp. 90 & 95) and Catechu (pp. 63 
& 64); if colliquative, mineral acids (pp. 42 & 61). One 
drop of Acid. nitr. d. in one teaspoonful of water will 
sometimes act like a charm. During my sojourn in the 
Phillipines — nearly thirty years ago — a lady patient of 
mine was at different times cured by that dose, when 
opium, bismuth and other drugs, even the nitric acid in 



Diphtheria. 201 

larger doses, which I at first used to give her, had been 
without the least effect. In the chronic form, Opium 
(pp. 35-7); Salicin (pp. 17 & 18); Ferrum (p. 66)', Alum 
and Cotoin (132 & 137); Phenol p. os v. p. anum (22 
& 382), etc. Diarrhoea, dependent on uraemia or cirr- 
hosis of the liver, is conservative, and therefore to be 
kept only within certain limits. For children, may, in 
addition, be mentioned Hydrargyrum cum Creta (pp. 
92 & 93), if clay stools; Kino (145); Argenium nitricum 
(133), if very obstinate, but without inflammation. 
Diarrhoea, during dentition, acts as a derivative, and 
should not be interfered with, unless the evacuations 
become watery or frothy, or they smell sour; the child 
beginning to emaciate, etc. See Cholera Infantum. 

Dilatatio Cordis et Ventriculi. See Heart resp. 
Stomach. 

Diphtheria — A general disease of an eminently epi- 
demic character, marked by a spreading inflammation of 
the mucous lining of the fauces and adjacent parts, 
attended with fibrinous exudation in form of false mem- 
branes, which usually appear first on the to?isils and the 
soft palate as greenish white, slightly elevated patches, 
and swelling of the submaxillary and cervical glands. 
Often the nasal cavity, the larynx and trachea are invaded 
by the diphtheric inflammation; sometimes the cheeks, 
gums and lips — even the anus, the prepuce, the vagina 
and the puerperal uterus may be attacked. Paralysis 
affects sometimes the muscles of the palate, pharynx and 
mouth in the course of the disease; but generally not 
until a few weeks after convalescence, and may extend to 
other muscles. Anaemia and general debility is apt to 
persist for a considerable period. There is always more 



202 Dislocation. 

or less pyrexia, and frequently vomiting; but the most 
constant and characteristic feature is the throat affection, 
hence the names angina or cynanche maligna, epidemic 
croup, etc. Diphtheria may be associated with scarlat- 
ina, measles and small-pox. Treatment — Aside from the 
Lime-steam bath (418), compresses or ice, with attention 
to disinfectants (420— note), one or the other of the follow- 
ing remedies, according to indications: Nitre (120); 
Thymol (34); Benz. (pp. 45 & 46)); Sulfo-carbol (p. 16); 
sulfites (pp. 18 & 19); Apomorph. (p. 107), if necessary, 
and brandy (p. 72), as support with milk, etc. Hydrargyr- 
um bijodatum (p. 13) has been lately recommended. 
Locally, Potassit ' Chloras, Phenol, etc. (287 & 294-300); 
Bromc (45 & 313) is used internally and as inhalation* 
Afterward, tonics (17 3); in paralysis, Strychn. (152 & 184). 

Dipsomania. See Alcoholism. 

Dislocation is called the dislodgement of the head 
of a bone from the cavity in which it is naturally placed, 
being characterized by an alteration in the form of the 
joint: an abnormal prominence at one part and a depres- 
sion at another, together with lengthening or shortening 
of the limb; and a loss of or deviation from the proper 
motions of the joint, with pain in motion. Great assist- 
ance to a correct diagnosis may be derived from com- 
paring the limb with the joint of the opposite side. 
From fracture it maybe distinguished by the absence of 
true crepitus i the distorted bone being neither freely 
movable nor shortened. Luxations, though easily re- 
duced at the time when the accident occurs 3 will cause 
considerable trouble later on. The reduction is accomp- 
lished by extension and counter-extension. The extend- 
ing force is to be gradually increased and applied at 



Dislocation. 203 

first in the direction in which the bone may be displaced^ 
but by degrees it is to be brought to a line parallel with 
the axis of the socket. At the same time some one 
should endeavor to raise the head of the bone over the 
edge of the cavity in ball and socket dislocations. _ After 
reduction leeches, fomentations or the ice bag and purg- 
ing (p. 9i ; ) must be used, if required, to prevent inflam- 
mation, and the joint should be kept at rest till any 
laceration of its ligaments has heeled. 

Dislocation of the jaio> which may be partial or com- 
plete, on one side only, or on both, is characterized by 
the protrusion of the chin forward or a little sideways, 
the mouth being fixedly open. The condyle may be 
felt to project unnaturally under the zygomatic process, 
whilst there is felt a hollow in the upper part of the 
parotid space. Treatment — After having fixed the head 
against the wall or the back of a high chair, the sur- 
geon should place his thumbs, wrapped in some cloth, 
at the roots of the coronoid process behind and outside 
of the molar teeth, and press these downward and 
backward, elevating the chin at the same time with 
his fingers. After reduction the chin must be supported 
for a, few days by a four-tailed bandage, to prevent 
accidental redisplacement from involuntary yawning. 

Dislocations of the wrist may readily be recognized by 
the altered position of the hand, which is thrown eitker 
backward or forward, or twisted on its axis with an 
outward or inward projection, and by the alteration in 
the relative position of the styloid processes of radius 
and ulna with the carpal bones. They are reduced toy 
simple extension. 

Dislocations of the hand — If the os magnum a&ib os 



204 Dislocation. 

cuneiforme are partially dislocated, they form projections 
at the back of the hand, which must not be mistaken for 
ganglia. The os pisiforme is sometimes dislocated by 
the action of the flexor carpi ulnaris. Tre a tmeni ^con- 
sists of pressure, mechanical support and cold affusions, 

Dislocations of the thumb, fingers and toes, which are 
difficult of reduction, aro best managed by taking a firm 
hold of the joint by means of a piece of tape, spread 
with adhesive piaster where it is m contact with the skin, 
fastened with the clove-hitch. It is a good plan to place 
a part of the tape round the head of the dislocated bone, 
so as to pull it into its place. Extension should be made 
toward the palm, so as to relax the flexor muscles. 

Displacements of Uterus (Prolapse, Flexions, Ver- 
sions, etc.). See Uterus. 

Dorsodynia. See Myalgia. 

Dropsy. General — A transudation into the serous 
sacs with anasarca, dependent either on obstructions — 
produced by diseases of the heart and lungs, which 
impede the return flow of blood from the vena cava, or 
by certain affections of the liver, which cause portal 
obstruction, — or on a morbid condition of the blood, as in 
Bright's disease, and the cancerous and tuberculous 
cachexy: the hydremic dropsy, attending the two latter 
diseases is usually less in degree than that in kidney dis- 
ease. General dropsy arising from mitral lesions, occurs 
after enlargement by dilatation of the right side of the 
heart has taken place, and the dusky hue, combined with 
oedema, gives to the face an appearance as distinctive of 
cardiac disease as the pallid aspect, which characterizes 
general dropsy from renal disease. Treatment — Diu- 
retics, diaphoretics and hydragogues, followed by tonics, 



Dysmenorrhea. 205 

are the remedies, in conjunction with paracentesis (p. 
144 — note), and multiple punctures to allow the escape of 
fluid, where much oedema. Potassa (pp. 53 & 96); 
Jaborandi (pp. 51 & 110); Blatta and Scilla (pp. 47 & 
58), etc. Elaterium, Gamboge, Jalap (pp. 91 & 92). Aside 
from these there may be mentioned Cole hi cum and Colo- 
cynthis (pp. 47 & 91), which are often employed in 
dropsy from heart and liver disease; the former com- 
bined with Digitalis (p. 50), the best heart tonic. Copaiva 
(pp. 48 & 49) in B right's disease; Ammonum (p. 43) if 
dysentery be the cause), and Nitre or Calomel (pp. 57 
& 92) if from scarlatina. Scilla, Iodine or Iodoform 
(401 & 413) externally, or Juniper inhalations (322), 
especially where the state of the stomach precludes the 
use of diuretics. See Hydro-peritoneum and Anasarca. 
For Ovarian Dropsy see Ovaries. 

Dysentery — A specific inflammatory disease of the 
large intestines, occurring in all possible forms— from 
the simple catarrhal and sporadic to the diptheritic and 
epidemic — all of them characterized by mucous and 
bloody stools, accompanied by griping pains and ten- 
esmus of more or less severity. Treatment — In the 
acute form, aside from hot fomentations to the abdomen, 
Opium (pp. 36 & 136); Bismuth, Plumbum (99 & 147); 
Creta, Catechu (i07 & 135); or Calomel (12), according 
to circumstances. If chronic, Creosote, Cuprum (138 
& 39); Alum, Ergot (pp. 62-65); Arsenic (p. 9); Ipeca- 
cuanha (p. 82), etc. — Nitre (p. 57), as drink; and brandy 
(p. 72), as support. See Diarrhoea. 

Dysmenorrhea — Difficult menstruation, attended by 
more or less pain, and dependent on one or more of the 
following factors: A depreciated condition of the con- 



206 Dysrn enorrh oea . 

stitution, beginning usually either in the nervous system 
or blood, which creates a tendency to neuralgia; an- 
abnormal state of the uterus, or diseased ovaries. 

Neuralgic Dysmenorrhea may be caused by a neural- 
gic diathesis; chlorosis or plethora; malaria and rheu- 
matism; luxurious and enervating habits, as onanism or 
excessive venery, etc., and is characterized by simple 
neuralgic pains, with an occasional spasmodic element. 
Treatment — Aside from attention to cause — tents, or a 
galvanic pessary locally; or the occasional passage of a 
sound to the fundus uteri may do good (pp. 129-31). 
Internally, sedatives — Asa fodtida, Brom, Chloral, Canna- 
bis, Hyoscyamus, etc. (pp. 23-33); Aurum or Guagac 
(pp. 9 & 12), are sometimes of service; or Amy I as in- 
halation (308), and if the pain is of a spasmodic nature, 
enemata of Asa fcetida or Belladonna (365 & 381) or, 
suppositoria (3*50, 374 & Id). Parturition will in most 
cases cure this form entirely. 

Congestive Dysmenorrhoea, which may be caused by 
general plethora; sluggishness of the portal circulation, 
exposure to cold; sudden mental disturbances, displace- 
ments (perhaps the most frequent cause), and womb 
diseases, is characterized by severe pelvic pains, accom- 
panied by diminuition or cessation of discharge and con- 
siderable constitutional disturbance — pyrexia, headache, 
nervousness, restlessness, and sometimes rectal and 
vesical tenesmus or diarrhoea. In the inflammatory 
kind there will be pain also during the inter-menstrual 
periods, difficult locomotion; leucorrhcea, fatigue and 
similar symptoms. Treatment — Removal of cause if 
possible; and local inflammation, if it exist, should be 
treated first. If due to plethora or sluggish portal cir- 



Dysmenorrhea. 20*7 

eolation, next to exercise, cathartics — Colocynthis (203); 
Calomel (ip. 93); salines (2 19), according to circumstances, 
and a pediluvium (419) at the menstrual period. Some- 
times the lancet may be necessary; or from two to four 
ounces of blood may be taken from the sacrum by cup- 
ping, to be repeated within a fortnight if required. See 
Amenorrhoea. Difficult menstruation, due to cold, de- 
mands diaphoretics, especially Ammonii Acetas (p. 43), 
with sedatives — Brom, Morphium (51 & 255), etc. 

Obstructive Dysmenorrhoea,wh\ch, barring a contracted 
cervix, or flexions and versions, may be caused by polyps 
in utero, or fibroid in the parenchyma of the neck; vagi- 
nal stricture or obturator hymen, is characterized by 
severe spasmodic pain [uterine colic), which comes on a 
few hours after menstruation has continued, and suffi- 
cient blood been collected in the uterus to distend it, 
and which passes rapidly into a violent expulsive effort 
like the co?itractions in miscarriage, accompanied by the 
passage of some blood. If the obstruction exist in the 
cervical canal, the efforts of the uterus will generally 
expel first a small clot, w r hich is followed by a gush of 
liquid blood. Treatment relates to the obstruction. 

Membranous Dysmenorrhea ;, being due to an exuda- 
tion of coagulable lymph, like that in croup, is char- 
acterized by steady pains, which, w T ith the progress of 
the menstrual flow, become violent and expulsive, like 
those of abortion, and end only with the discharge of the 
exfoliated mucous membrane of the uterus, either in 
shreds or entire — a false mole. Treatment — Ammonium 
(p. 43), with Morphium or Ether (255 & 304) to relieve 
pain. Alterative applications may be tried — Argentum 
nitricum, Jod, Chiom, Phenol, Ferrum (343, 41, 48, 51 



208 Dyspareunia. 

& 6*7); or, if the patient be married, she may be put 
under the full effect of Mercury. See Amenorrhoea. 

Ovarian Dysmenorrhea, caused by chronic oophor- 
itis, is characterized by great pain in the affected ovary, 
the pain generally preceding the bloody flow several 
days, and diminishing as it is established; sometimes 
appearing even in the inter-menstrual period; and often 
accompanied by mental depression. Frequently the 
breasts will sympathize, becoming painful and tender. 
Treatment — Aside from replacing the ovary, in case it be 
prolapsed, a warm sitz bath or pediluvium (419),with warm 
soothing injections (358), and leeches to each groin if 
necessary. Sedatives in conjunction with suppositoria 
of Iodoform, etc. (350, 374 & 75), may be indicated. 

J)ysmenorrhoea consisting of more or less of the ele- 
ments of the various forms jointly, as usually is the case y 
demands, if severe, recumbency in bed, Brom and 
Chloral, with or without enemata or suppositoria (3 75 
& 381). At the same time, according to indications, 
Aloes, Calomel (pp. 89 & 93); or Borax (p. 55); Berb., 
Viburnum (44, 85 & 162); or Phosphor (154), etc. 

Dyspareunia — Painful coition, which may, aside from 
being the consequence of too frequent, too impetuous, 
or too protracted coition, be due to a number of causes, 
as chronic poritonitis or cellulitis, endometritis, displace- 
ment of uterus, requires the treatment of these diseases. 
If there is a hypersensitive condition of the carunculm 
after laceration of the hymen (vaginismus — see Vagina) 
or erosions in the vaginal orifice produced by leueorrhoea, 
Argent.nitr.(3i3). Sometimes vaginal suppositories (3 5 6) 
are of benefit — rectal ones will be preferable if, at the 
same time, a constitutional effect should be required. 






Dyspepsia, 209 

Dyspepsia [Indigestion) — Functional disorders of the 
stomach or small intestines, or both; mostly chronic, and 
characterized by imperfect digestion — indigestion proper 
— or perfect but difficult digestion, dependent, among 
othercauses, on dietetic excesses, sedentary habits, mental 
anxiety, anaemia, hysteria, etc. Whilst difficult digestion 
is attended by a sensation of fullness in the region of the 
stomach, with a general feeling of heaviness and dis- 
comfort, indigestion will produce regurgitation, cardial- 
gia, tympanitis or vomiting; but either may be asso- 
ciated with more or less languor or incapacity for work 
after a meal, which feelings sometimes will last for 
hours. In many cases the urine deposits a lateritious 
sediment, which generally contains oxalate of lime in 
abundance. Treatment — Acute Dyspepsia, popularly 
called a bilious attack, with or without headache, and, 
among other causes, due to over-repletion of the stom- 
ach, the ingestion of indigestible food, or an arrest of 
digestion by strong emotions, etc., rarely requires medi- 
cation. Blue pill (p. 92), followed by a cathartic (p. 97), 
and afterward Quinine (p. 76), or some other tonic will 
at any rate suffice. In the chronic form, which is some- 
times very obstinate, the diet should, above all, be regu- 
lated; if gastric, farinaceous and fatty articles as food; 
if intestinal, albuminoid substances and meat. Medica- 
tion according to circumstances. In atonic indigestion 
— of sedentaries — Hydrastis, Absinth, and Alcohol (pp. 72 
& 82); if constipation, Aloes, Podophyll., Rheum (pp. 
89-94), and other tonic aperients; if dependent on the 
liver, alteratives (p. 7); if due to fermentation and putre- 
faction in the alimentary canal, Naphthol (21); or Saiicin 
(25 & 29), etc. In heart-burn (cardialgia) : a burning 



210 Dyspnoea. 

pain over the pit of the stomach, and shooting upward 
into the throat, alkalies (pp. 53-5) — taken before meals 
they increase the flow of gastric juice — ,Berberis, Guar- 
ana (pp. 24 & 81), etc. In waterbrash (pyrosis) : regur- 
gitation of insipid, saltish or acid liquid in the morning 
when the stomach is empty, Bismuth or Soda (p. 46); 
acids or Pepsin (pp. 71 & 84). If foul taste, Nitro-mur. 
acid (153). If morbid sensibility of stomach (pain and 
distress after eating, or diarrhoea excited by food), 
Arsenic, Creosote, Argentum (pp. 9, 64 & 74) ; Brom (p. 25). 
If tympanitis, alkalies, Bismuth, Ammon., Carbo (93, 103 
& 159), or Benzin, Creosote (97), etc.; (a little brandy 
is sometimes of service). In hysterical flatulency, Asa 
fcetida and Valeriana (41); Strychn., Ferr. (pp. 80 & 81); 
Glycerin and Pancreatin (pp. 8 1 & 84). If ansomia, acids; 
Ferr. c. Chin. (p. 76). In dyspepsia of drunkards, Ammon. 
(159); or Capsicum (pp. 75 & 82). If vomiting. Cyan, 
Cerium (67 & 59); sulfites (33). See Vomiting. 

Dyspnoea — A difficulty of breathing, dependent on 
deficiency of oxygen in the blood. Treatment according 
to cause — Ammon. (158); Amy/ (37 & 308). See Lungs. 

Dysphagia. See (Esophagus. 

Dysuria. See Bladder (Spasmus vesicae). 

Ear — Foreign bodies in the meatus should be removed 
as quickly as possible, when it can be done by gently syr- 
inging the ear with warm water, which procedure may 
even be repeated at short intervals, if required; else the 
substance had better be left alone, as foreign bodies are 
known to have remained in the ear without permanent 
injury for years. Except in the case of soft or fibrous 
substances lying just at the entrance of the passage, 
other instruments should not be used, as they will only 



Ear. 211 

do harm. (To get a proper view of the inside, in exam- 
ining the ear by speculum, the auricle must be drawn 
outward and backward). 

Deafness, if organic, depending on concussion or rup- 
ture of the auditory, is incurable. See sub-acute and 
chronic inflammation of tympanic cavity. If functional 
and dependent on debility, Rmmon. (p. 73) may be tried; 
or Arnica, Valeriana (pp. 74 & 29), etc.), with Glycerin, 
Phenol or Camphora (274 & 78) locally. If caused by an 
accumulation of wax, the syringe. (Glycerin dropped 
into the meatus, and retained by a tampon of cotton 
for twenty-four hours, will facilitate the removal). 

Catarrhal or Throat Deafness, which depends on a 
morbid state of the mucosa lining the Eustachian tubes, 
generally associated with swelled tonsils and relaxed 
throat, is characterized by ringing and crackling noises 
in the ear. It is easily diagnosed by means of the oto- 
scope. When the patient, with firmly closed mouth and 
nose, makes an 'effort, as in blowing the nose or swallow- 
ing, the shock of air against the membrana tympani 
may be heard, if the tubes are pervious, or a gurgling 
- : ind, if they contain fluid; whilst, if they are imperv- 
ious, there will be no sound at all. Treatment — Aside 
from tonics (p. 70), to brace the system, astringent garg- 
les (321), inhalations of Creosote or Iodine (336); abridg- 
ing of the tonsils if necessary, and catheterism of the 
Eustachian tubes. As the latter operation requires 
much skill, the following procedure may answer as well: 
The mounted end of a short flexible tube attached to 
Politzer's india-rubber bottle is introduced into one 
nostril, which is then closed by the surgeon. The 
patient is now told to swallow — having taken some 



212 Ear. 

water into his mouth for the purpose — and during the 
act the surgeon squeezes the bottle, so forcing the air 
through the nasal cavity into the tubes. 

Tinnitus Aurium — Noises in the ear, accompanied 
with more or less deafness, a symptom which may be 
due to anaemia, grief, anxiety, and a general weakened 
state of the system. (When occurring in the decline of 
life it is seldom amenable to a cure). Treatment con- 
sists of a generous diet and out of door life, with Ferrum, 
Zinc, Valeriana (174 & 196), etc. 

Otalgia — Earache, unless inflammatory, is neuralgic, 
and usually due to carious teeth. It is characterized by 
fits of excruciating pain, shooting over the head and 
face. (Inflammatory pain is throbbing and accompanied 
by fever). Treatment — Locally may be tried Atropia, 
Camphora, Chloral, Phenol or Cocaine (174-9); internally 
cathartics (p. 88), with tonics (p. 69), if necessary. 

Otitis externa — Catarrhal inflammation of the lining 
membrane of the meatus, occurring chiefly in delicate 
children whilst cutting their teeth, or as a sequel of the 
exanthemata, and frequently associated with strumous 
ophthalmia. It is characterized by more or less fever- 
ishness, swelling of the meatus, soon followed by a thin 
yellowish discharge, and ear-ache. Aside from a con- 
stitutional treatment, purgatives (p. 88), with foment a- 
tions or poultices (p. 114), locally; and if the discharge 
continue, astringent injections (p. 114), with counter- 
irritation. Should the discharge stop suddenly, and an 
attack of acute pain and fever come on, the injections 
must be discontinued, and purgatives, with fomentations 
— if necessary, leeches — must be again resorted to. 

Otitis interna — Acute inflammation of the membrana 



Ear. 213 

tympani and the tympanal cavity, which is frequently 
connected with measles, scarlatina, rheumatism, gout 
and scrofula; but which may be due also to cold, sea- 
bathing, violent syringing and otherwise irritating an 
inflamed ear, is characterized by swelling, tenderness 
and dryness of the meatus. Suppuration within the 
tympanum and mastoid cells, with, occasionally, facial 
paralysis, may follow; and the membrane finally ulcerate 
and burst. Whilst in neglected cases inflammation or 
suppuration within the cranium may occur and prove 
fatal, in less severe ones, the membrane may be left 
thickened and opaque; and the cavity blocked up by 
adhesions; or there may remain an obstinate discharge 
with caries of the bone, and mischief within the cranium, 
hereafter. The inflammation is attended with sudden 
and intense pain (often so excruciating as to produce 
delirium), which is increased by coughing, sneezing and 
swallowing— always worse at night — in conjunction 
with tinnitus aurium, more or less deafness and violent 
fever. Leeches should be repeatedly applied to the mas- 
toid prominence and in the depression immediatelybelow 
the auricle, and by means of a leech-glass to the orifice 
of the meatus itself. Should the acute symptoms not be 
mitigated, and there be any sense of fullness, swelling 
or fluctuation over the mastoid process, an incision, an 
inch long, should be made with a stout scalpel down to 
the bone, parallel to, and half an inch from the attach- 
ment of the auricle. When the acute stage is subsiding, 
a portion of the incision may be converted into an issue, 
or blisters may be employed. Neuralgic pain, accomp- 
anying otitis, may be allayed by applications of anodynes 
behind the auricle, Aconite, Belladonna with Opium, Co- 



214 Ear. 

caine (263 & 350), etc. If the membrane should bulge 
outward on account of the pus within the cavity not 
being able to escape through the Eustachian tube, it may 
be perforated at its lower and posterior portion (to avoid 
the ossicula), by means of a sharp-pointed steel probe. 

In the sub-acute and chronic form, where the changes, 
wrought in the tympanic cavity give rise to the majority 
of cases of deafness, though the symptoms are but slight 
— a woolly sensation, 'occasional noises with variable 
obtuseness of hearing and slight aching, — and which 
most frequently is associated with a rheumatic or gouty 
diathesis, a constitutional treatment is imperative. Iodine, 
Sublimate (pp. 13 & 14); sometimes Hydrargyrum c. Creta, 
gr. j bis die, is of service. At the same time counter- 
irritants in the shape of Iodine (20), or small blisters 
(408), over the mastoideus, with occasional leeches, if 
they give relief to pain, noises and headache. In child- 
ren of weakly habit this form may exist still more in- 
siduously: they may cry when it is washed; or they may 
like to have it tickled; or they may put their hands to 
it, or roll their heads on their pillows; but no real com- 
plaint is made. Aside from counter-irritants and tonics, 
Ferr. jod. (p. 15), especially if the tympanum is bulging. 

Perforation of the Membrana Tympani, which, if 
large, will cause considerable deafness, may be the con- 
sequence of injury— blows on the head, or a box on the 
ear, etc., — but it is mostly a result of otitis and suppura- 
tion within the cavity, or ulceration of the membrane 
itself. If the opening be small, Argenti Nitras applied 
by means of a fine probe coated with it, may cause the 
aperture to heal; but if the loss of substance is great, 
a substitute for the membrane is the only remedy. 



JEchinococcus. 215 

Otorrhoea is either the result of catarrhal inflamma- 
tion of the meatus — see Otitis externa — or the conse- 
quence of otitis interna. In purulent discharge follow- 
ing the latter, the ear should be twice daily very gently 
syringed with warm water, and immediately afterward a 
tepid lotion of Alum, Zinc or Plumbum (277 & 81) be 
dropped into the meatus till it is filled, to remain there 
for about two minutes. If the discharge is very fetid, 
Phenol, Salicin, Mangan (274, 75 & 81); and if very 
obstinate, the interior of the meatus may be pencilled 
twice a week with So/utio Argenti nitrici (gr. v: § j). If 
the fetid discharge is caused by caries of the petrous or 
mastoid bones as consequence of suppuration within the 
tympanum or mastoid cells — in which case palsy of the 
side of the face will be present — the dead bone may be 
felt with the probe. (An early incision down to the 
mastoid bone may prevent caries). 

Polyps in the ear may be extracted; but perhaps 
equally effective, and less liable to set up irritation, is 
the application of Alumen pulveratum by means of an 
insufflator, in connection with astringent lotions, with 
which the meatus should be regularly injected. 

Fungous Granulations, which cover sometimes the 
membrana tympani, may be treated with Argentum 
nitricum and astringent lotions; Alum or Tannin. 

As all inflammatory affections of the external meatus 
may implicate the brain, care should be taken to have 
always a free exit for the discharge- 

Echhstococcus (Hydatid) — The scolex or larval stage 
of Tcenia echinococcus, a small tapeworm of about five 
mm. in length, which infests the dog, mostly in the 
liver; but the cyst may exist in any part of the body. 



216 Elephantiasis. 

Treatment — Puncturing the tumor with a fine hollow 
needle or trocar, and withdrawing a portion of the 
liquid from the sac by aspiration, will generally suffice 
to effect a cure; but electrolysis (p. 150) is preferable. 

Eclampsia. See Convulsions. 

Ecthyma and Eczema. See Skin. 

Ectopic Gestation. See Pregnancy (extra-uterine). 

Elephantiasis Arabum — A disease of warm climates, 
consisting in a slow hypertrophy of skin, areolar tissue 
and bones; and affecting generally the leg or the scro- 
tum, resp. the labia. Amputation of the diseased part is 
the only remedy as yet known. 

Embolus. See Brain, resp. Lung. 

Emissions. Seminal. See Spermatorrhoea. 

Emphysema vesiculare — An abnormal accumula- 
tion of air within the alveoli, whereby they become 
distended, and their walls often atrophied, produced 
mainly by forcible efforts of expiration, and generally 
preceded by or associated with bronchitis or asthma. 
It is characterized by the barrel-shaped chest, with an 
abnormal intense resonance on percussion; and leads 
invariably to hypertrophy and dilatation of the right 
ventricle with venous congestion— £Ag cyanosed hue of 
the face being most markable during paroxysms of couglu 
ing — on account of the obliteration of pulmonary capil- 
laries, causing obstruction to the flow of blood through 
the lungs. In slight cases want of breath will be appar- 
ent in speaking, singing, especially in laughing or walk- 
ing fast; more severe ones are characterized by habitual 
labored breathing, consisting of a prolonged expiration 
and a remarkable short inspiration. In JE. senile the air 
<eells coalesce and form also larger air spaces; however 



Enteritis. 217 

not as result from a dilatation of the alveoli, but from a 
gradual shrinkage of the lung-tissue, dependent chiefly 
in the lessened elasticity of the lung in old age, the 
lungs are smaller and contain less air than normal — 
hence the size of the chest will be diminished instead of 
being increased. The Treatment resolves itself into that 
of bronchitis and asthma: Chloral, Cyan, Grindelia (60, 66 
& 72); Lobelia or Ammon. (15 & 94); Arsenic and Val- 
eriana (pp. 9 & 29) ; or inhalations of Cannabis, Asa fcetida, 
Iodine, etc. (311, 315 & 21). In senile atrophy Ether 
(304) will sometimes afford relief. 

Empyema. See Pleuritis suppurativa. 

Endocarditis. See Heart. 

Endometritis. See Uterus. 

Engorgement of Breast and Uterus. See Breast, 
resp. Uterus (Hyperplasia). 

Enteralgia — A neuralgic affection of the intestines, 
characterized by intermitting and remitting pains within 
the abdomen, and frequently associated with gastralgia 
{gastro-enteralgia). Treatment like that of the latter and 
other neuralgic affections. See Colic (intestinal). 

Enteralgia from lead — Painter's Colic is a neuralgic, 
more remitting than intermitting affection of the intes- 
tines, extending sometimes over the whole abdomen, but 
generally confined within a small space; in conjunction 
with pains in chest, back and limbs, and often a peculiar 
discoloration of the gums at their junction with the teeth, 
dependent on chronic lead poisoning. Treatment accord- 
ing to indications — Acidum sulfuricum (p. 61) ; Alum (132); 
Chloroform and Iodine (pp. 31 & 15); Sulfurated bath (419). 

Enteric Fever. See Typhoid. 

Enteritis (Catarrhus intestinalis) — An inflammation 



218 Enteritis. 

of the mucous membrane of the small intestine, char- 
acterized by pain and tenderness on pressure over the 
abdomen, and frequently attended with diarrhoea, nau- 
sea and vomiting; (jaundice, if the duodenum is in- 
volved). The acute form is generally a consequence of 
over-indulgence in eating and drinking, the use of dra- 
stics and poisoning with acrid substances; sometimes it is 
due to cold, when the body is heated and perspiring. 
Subacute it arises from dietetic errors or from arrest of 
digestion through exposure to cold, over-exertion, etc.; 
whilst the chronic form is usually referable to some 
prior morbid condition, especially valvular lesions,chronic 
pleuritis, emphysema and cirrhosis, which lead to it by 
obstructing the circulation in the portal system. (This 
form occurs also in tuberculosis, oxaluria and Bright's 
disease.) The Treatment of the acute and subacute form 
embraces mild purgatives, followed by anodynes and regu- 
lation of diet. Aloes (201); Opium (p. 37); fomenta- 
tions will be sometimes of service. Compare Gastritis- 
In chronic enteritis the cause must be removed as far as 
possible. Argentum, Cuprum, Plumbum (133, 139 & 47). 
See Diarrhoea. 

Enterocele. See Hernia (entero-vaginal). 

Entozoa. intestinales. • See Helminthiasis. 

Enuresis. See Bladder (Paralysis vesicae). 

Ephidrosis — A morbid and excessive secretion of the 
sudorific glands, generally a concomitant of catarrhal 
and rheumatic aifections. Treatment — Acidum sulfuri- 
cum v. gallicum, Arctostaphylum (pp. 61 & 68), etc. In 
night-sweats, Ergot, Quinine or Atropia (pp. 76, 78 & 23); 
Tannin or Agaricin with Pulvis Doveri (pp. 62 & 63) are 
particularly recommended. For sweating feet, a wash 



Epilepsy. 219 

containing Acidum nitricum, or a powder with Acidum 
salicylicum (395), or Vinegar; if fetor, Borax, Soda, Man- 
gan or Phenol (334, 390 & 98). 

Epididymitis. See Testes. 

Epilepsy — L<: grand mal of the French is a chronic, 
paroxysmal neurose, characterized by a sudden and com- 
plete loss of conciousness, associated with tonic and 
clonic convulsions; respiration during the former nearly 
suspended, during the latter irregular and labored; ejec- 
tion of foamy saliva, frequently mixed with blood; 
sometimes urine is voided and feces are expelled, even 
a seminal emission may take place. The attack may 
last from a few minutes to half an hour, and is followed 
by more or less exhaustion, and a disposition to sleep. 
In some cases the fit consists only of vertigo, a moment- 
ary loss of consciousness and a state of confusion or 
deep abstraction. These are called epileptoid attacks 
— le petit mal of the French. The morbid condition 
giving rise to epilepsy is seated in the medulla oblongata 
and pons Varolii; however, the toxic agent is as yet 
unknown. Intra-cranial lesions and cerebral anaemia 
are sometimes connected with it, and of other causes 
may be named intemperance, venereal excesses, lead 
poisoning and phimosis, even intestinal worms. Treat- 
ment according to cause — Calomel (207) ; Amyl(Sl & 308); 
Belladonna (pp. 23 & 24); Anilin or Camphora (38 & 50); 
Digitalis (1 7.1); Apomorphin (240); Woorara(2h§)\ Argent- 
urn, Capsicum and Zinc (160, 1 70 & 194); Lithium (110); 
if suppressed menses be the cause, Croton (225), etc. 
Of all the remedies Brom (pp. 26 & 27) takes the lead, 
as it may be taken for years, if care be taken to discon- 
tinue it for a few days whenever Bromism is produced. 



220 Erysipelas. 

Epistaxis. See Hemorrhage from the nose. 

Epithelioma. See Carcinoma. 

Epulis. See Mouth. 

Erosions of Cervix. See Uterus (Degeneration). 

Eruptions or Exanthemata. See Skin. 

Eruptive fever. See Fever. 

Erysipelas — A diffuse inflammation of a low type, 
affecting the skin: simple erysipelas, or skin and areolar 
tissue: phlegmonous erysipelas, with a tendency to spread, 
and accompanied by fever — the high temp, being diag- 
nostic. It attacks generally the face, spreading to scalp, 
throat or trunk; but it will affect with predilection in- 
jured parts all over the body. Treatment as in septi- 
caemia and according to the severity of the case — Warm 
poppy fomentations; flour, dusted over the inflamed sur- 
face; cotton as cover, or pressure by means of bandages; 
Argenti Nitras, lohthyol, Cocaine, etc. (404 & 5); Naph- 
thoic Creosote (390 & 98), or Phenol as injection (p. 107). 
A hypodermic injection of Sublimata (0.0006) bis die is 
said to be very efficient. Minute punctures, about 2 mm. 
deep, may be made with the point of a lancet in simple; 
deep incisions, about 3 cm. long, carried to the diseased 
tissue in phlegmon. Rapid strokes with a red hot iron 
over the erysipelatous surface, previously covered with 
a thick layer of felt, so as to strongly warm the affected 
part, are also recommended. Internally, sulfides (pp. 
18. & \$)\Mangan (p. 82); Brom (48), if delirium. Aconite 
(p. 22) is said to act abortive in the sthenic type, with 
Zealand Opium wash (337), applied hot, and the com- 
presses covered with oiled silk. Ammon. and Terebinth. 
(pp. 43 & 67), in cardiac weakness. If constipation, 
enemata (385 & 86); if diarrhoea and sickness (from 



Eye. 221 

irritable stomach), Bismuth or Mercury (pp. 46 & 93). 
If there be bilious vomiting in idiopathic erysipelas, it 
is well to purge — a hot Mustard poultice over the epi- 
gastrium gives sometimes instantaneous relief. Bella- 
donna (p. 24) in idiopathic facial. In the rest, brandy 
(p. 72) as support, and tonics — Ferrum (pp. 66 & 79) is 
only of service in simple facial, if idiopathic; and Quinine 
is in all cases, if not dangerous, at least useless, as the 
dilatation, that precedes the contraction of the blood- 
vessels, does harm. 

Erythema. See Skin. 

Exanthemata and Exanthematous Fevers. See 
Eruptions and Fevers. 

Excitement (Nervous) will in many cases yield to a 
Seidlitz powder, Brom (p. 25), or Nitre (124). The latter 
is particulary useful, if caused by fright. See Hysteria. 

Excoriations. See Skin (Intertrigo). 

Exhaustion. See Debility. 

Eye — Ojjhthalmitis is called the inflammation,in which 
all the inner structures of the eye are more or less in- 
volved. It is characterized by a bright pink red of the 
sclerotica; the iris discolorated from increased vascu 
larity or effusion, sometimes adhering to the capsule of 
the lens, sometimes bulging; in severe cases enlarge- 
ment of the whole eyeball, swelling of the lids, chemosis, 
scalding tears and suppuration — the latter is indicated 
by shiverings. It is accompanied by agonizing pain, 
and generally caused by injuries or sympathetically in 
consequence of disorganization of its fellow. Treatment 
— Removal of foreign bodies, chemical irritants, etc., 
as far as possible; perfect rest of the eye by keeping it 
closed and cold compresses. At the same time purgatives 



222 Eye. 

(p. 88), and to allay pain, Opium or Cocaine (pp. 35 & 
112). Prolapse of the iris in consequence of penetrating 
wounds of the cornea, may sometimes be reduced by 
closing the eye and very gently rubbing the lid against 
the cornea, and afterward exposing it to a strong light, 
to cause the pupil to contract. Atropia or Physostigmirs 
(pp. 112 & 13). A foreign body having passed deep 
into the globe of the eye, so that it cannot be extracted, 
if it cause no irritation, may be allowed to remain, as it 
might become encysted; otherwise it will be well to 
enucleate the eyeball at once, to prevent the loss of the 
other eye from sympathetic ophthalmitis. 

Foreign bodies inside the lids may easily be removed 
by everting these; when in the cornea, Cocaine (263) 
will be useful. For injuries with acids or alkalies, or 
for removal of particles of lime or mortar, syringing with 
water is the best and readiest remedy. Blows on the 
eye are generally followed by ecchymosis; sometimes 
by an effusion of blood in the anterior chamber, which, 
however, is mostly absorbed within a fortnight, if in- 
flammation be kept down. A deposit of pus in the 
anterior chamber (hypopion) is mostly a consequence 
of acute iritis — see Keratitis suppurativa. 

Iritis — Inflammation of theiris, which always involves 
other interior parts of the eye, thus constituting in reality 
ophthalmitis, is generally dependent on a rheumatic or 
syphilitic taint. It is characterized by discoloration of 
the iris, irregular contraction, immobility of pupil, more 
or less vascularity of the sclerotica, making the whole eye 
appear of a pink redness, associated with dimness of 
vision, intolerance of light, and pain — especially 
a neuralgic aching of the brow and parts around the 



Cornea. 223 

orbit in nocturnal paroxysms. Treatment is directed 
to the special cause; for the relief of pain, Atropia (262). 

Cornea — Acute Keratitis, characterized by a red and 
opaque cornea, with a highly vascular sclerotica around 
it, and leading sometimes to ulceration, is frequently a 
consequence of neglected injury. Treatment — Next to 
rest, fomentations, and if it be necessary, a few leeches 
to the temples, or tapping of the anterior chamber. A 
nourishing diet in conjunction with tonics (p. 70) is 
sometimes required. 

Keratitis parenchymatosa — Strumous corneitis has, in 
addition to the above characteristics, a tendency to in- 
flammation of the iris and retina. The cornea becomes 
unusually prominent. Treatment — If acute, fomenta- 
tions and cathartics (p. 88); for the chronic form, re- 
peated blisters (408) to temples and behind the ear, with 
tonics and alteratives — Jodine (p. 14); Quinine and Iron 
(p. 76); Oleum Jecoris (p. 84), etc. 

Keratitis pixlyctenulosa begins with a phlyctenula on 
the epithelium of the cornea, which becomes a nodule, 
changes soon into a vesicle, and ultimately an ulcer, 
being accompanied with great intolerance of light, so 
that the lids keep spasmodically closed, and the tears 
gush forth on every attempt to open them. If the 
pimple forms on the conjunctiva {Conjunctivitis phlyc- 
<hsa) there is less photophobia. The disease lasts 
about ten days, but generally recurs. Treatment — Aside 
from cathartics and tonics, poppy fomentations and small 
blisters behind the ear; afterward Calome 1 (268). Pho- 
tophobia and Blepharospasm are sometimes relieved by 
Conium (63 & 264), or Woorara (259). 

Keratitis suppurativa — Either an abscess on the sur- 



224 Eye. 

face of the cornea, usually called ulceration of the 
cornea, or an interstitial abscess — a yellow pus spot with 
a sharp edge, or diffused in any part of the cornea. In 
the latter form the pus should be evacuated early by 
tapping the aqueous tumor after having applied Atropin 
(262) to prevent prolapse of the iris. 

Ulcus Corneoe — When as consequence of a scrofulous 
phlyctenula, the ulcer is generally deep, and tends to 
perforate the cornea, leaving an opaque cicatrix; when 
arising from other causes, it is often superficial. Again 
ulcers may form on a surface that is already rendered 
nebulous or opaque by inflammation. The general 
treatment as in phlyctenular inflammation; locally, fre- 
quent fomentations; Bor or Iodoform (263 & 69), and 
keeping the eye warm and closed with cotton and a 
light bandage. 

Conjunctivitis catarrhalis — Inflammation of the con- 
junctiva is characterized by increased lachrymal secre- 
tion, a mucous or muco-purulent discharge, attended 
with smarting, heat, stiffness and dryness of the eye, and 
a feeling as if sand had got into it. It is dependent on 
cold, local irritation, and sometimes on a weak constitu- 
tion. Treatment— \jq\aox\% of Zinc, Alum, etc. (261 & 75), 
and, perhaps, tonics (p. 70). in the chronic form Iodo- 
form (269) may be tried. 

Conjunctivitis purulenta — A violent inflammation with 
a thick, purulent discharge, which supervenes after one 
or two days duration, and may lead to ulceration or 
sloughing of the cornea, followed by inflammation of 
the internal parts of the eye. The form called contag- 
ious or Egyptian ophthalmia is not so destructive as the 
gonorrhoeal variety , which develops very soon after the 



Conjunctiva. 225 

contact with urethral pus. Opthalmia Neonatorum, 
which is generally produced by a vaginal discharge 
from the mother, specific or no, will, if neglected, also 
terminate in ophthalmitis. Treatment — Aside from rest 
and cathartics (p. 88), Argent/ Nitras (261), with cold 
compresses and Bor (260) locally. Hard chemosis, which 
is overlapping the cornea, should be freely incised. In 
infants, an early treatment with weak astringent lotions, 
as thea, combined with cleanliness, will generally 
suffice (261 & 67). 

Granulations on the conjunctiva consist either of en- 
larged papilla?, and are a sequel of chronic conjuncti- 
vitis or of an injudicious treatment with irritating 
applications; or they are enlarged lymph cells (trach- 
oma) in appearance, not unlike sago, which frequently 
co-exist with catarrhal or purulent conjunctivitis. They 
require a tonic treatment; locally, Bor (260); and some- 
times scarification. If chronic the part should be 
squeezed by means of trachoma forceps so as to com- 
pletely express the follicular contents. 

Pterygium — A morbid formation of the conjunctiva, 
a triangular portion of which, with the apex toward the 
cornea, becomes thickened, elevated, red and fleshy, and 
may spread over the cornea, so as to obstruct vision. It 
depends on continued exposure to heat. Treatment — 
The growth should be seized close to the cornea with a 
tenaculum forceps, cut quite across and dissected off 
toward the internal can thus, taking care not to extirpate 
the semilunar fold and caruncle. 

Nebula — A partial opacity of the cornea, which results 
from effusion between the corneal layers or between the 
cornea and conjunctiva from inflammation or healing 



226 Eye. 

ulcers. It will in time disappear without any treatment 
whatever. Arcus senilis is called a circumferencial lunated 
opacity of the cornea, depending on fatty degeneration, 
and supposed to be associated with alike condition of the 
heart. Leucoma or Albugo is a white cicatrix, produced 
through loss of corneal substance from ulceration, 
which is indelible — if it retains its vascularity it is 
called Pannus. 

Staphyloma of the cornea is said to exist when a por- 
tion or the whole of the cornea, disorganized by injury 
or disease, has perished, and the cicatrix, with which the 
iris has become covered, bulges before the pressure of 
the humors and forms an opaque, white prominence. 
Treatment — If growing it should always be removed to 
prevent further disorganization. Having transfixed the 
tumor with a needle or hook, it may be sliced off close 
to the eyelid, and cotton with a bandage applied. If 
the lens be present it must be taken out. 

Hernia Cornece — When the cornea is nearly perfor- 
ated by an ulcer, a thin vesicle is apt to protrude from 
the aperture, consisting of the posterior elastic mem- 
brane. The eye has to be kept closed for a few days 
by means of a bandage, to insure speedy cicatrization. 

Hordeolum — A stye is a small painful boil at the 
edge of the lid, having its seat in the follicle of a cil- 
ium. It is always dependent on a debilitated constitu- 
tion. Treatment — Aside from alteratives and tonics 
(pp. 8 & 69) to invigorate the general health, poultices 
or fomentations locally; afterward perhaps Ungt. Hydr. 
nitr. (266). The so-called tarsal tumor, which consists 
of one of the acini of the Maibomian glands of the lid, 
is situated very near, but never on, the margin of the lid, 



Palpebral. 227 

like hordeolum. It may be cut across with a small 
■>el, and the contents squeezed out. 

Eczema Palpebrarum {Ophthalmia Tarsi) — A usually 
chronic eczematous inflammation of the palpebral con- 
junctiva and the edge of the eyelids, with a morbid secre- 
tion of the Maibomian glands (so that the lids will stick 
together and become encrusted with dried secretion 
during sleep), leading frequently to ulceration of the 
lids, disease of the hair follicles, and loss of the eye- 
lashes; even to thickening and subsequent inversion 
of the edge of the lids. It mostly occurs to weakly 
persons with disordered digestion. Treatment — The 
lashes should be cut off, the eyes bathed with warm 
water several times daily, and at night the edges of the 
lids be smeared with lard or Ungt. Hydr. nitr. (26(5). 
At the same time aperients (p. 88); alteratives and tonics 
(pp. 8 & 69), and if possible, change of air. 

Trichiasis — A growing inward of the eyelashes, lead- 
ing to inflammation or ulceration of the cornea, and 
depending on some changes in the fibro-cellular tissue, 
in which the ciliary follicles lie. Treatment — If pluck- 
ing of the offending ciliae will not answer, roots and 
bulbs must be extirpated with the knife. 

Ectropion — E version of the eyelid, caused by a thick- 
ening of the conjunctiva, owing to chronic inflammation 
or to a cicatrix on the cheek; often it is a consequence 
of the cicatrization resulting from the healing of abs- 
ea at the edge of the orbit. Entropion — Inversion 
of the lid, produced by the unnatural action of that por- 
tion of the orbicularis palpebrarum which covers the 
edges of the tarsal cartilage. Operation is the remedy. 

Lagophthalmos — Hare-eye is called the inability of 



228 Eye. 

closing the palpebrae, and depends either on cicatrices 
or upon inaction of the orbicularis through palsy of the 
portio dura. In the latter case fomentations, a blister 
behind the ear, and aperients (p. 88), may suffice, unless 
it be due to some specific disease. 

Ptosis — A falling of the upper eyelid, whereby the 
eye is more or less closed, and depending on inaction of 
the levator palpebrce, in consequence of paralysis of the 
third nerve or on senile loss of power of the muscle; or 
it follows injury to the eyelid, whereby the nerve supply 
is more or less destroyed. In the first case, if it is at- 
tended with headache, giddiness and other signs of brain 
disturbance, the treatment should consist of rest, with 
purgatives, and locally, cold compresses; if caused by 
exposure to draught, tonics may be employed. In cases 
where general measures fail, a surgical operation. 

Symblepharon — Union of the eyelid to the ball, 

produced by ulceration of the lid and the surface of the 

globe in consequence of some accident, is generally 

irremediable. 

i 

Pediculi — -These parasites lodge sometimes about the 
roots of the eyelashes, and produce obstinate itching. 
Unguentum mercuriale is the remedy. 

Epiphora — An over- secretion of tears, so that they 
run over the cheeks from irritability of the lachrymal 
gland or a hypersemic state of the conjunctiva, common 
in scrophulous children. Aside from warm local appli- 
cations, purgatives, alteratives and tonics. 

Xerophthalmos — Dryness of the eye from deficiency 
of the mucous secretion of the conjunctiva in conse- 
quence of severe inflammation or too much cauteriza- 
tion, and may be relieved by applying milk or Glycerin. 



Lachrymal Apparatus. 229 

Stilliciclium lachrymamm — Watering of the eye is 
caused by an over-flow of tears in consequence of an 
obstruction somewhere in the lachrymal apparatus. If 
the punta lachrymalia be closed in consequence of in- 
flammation in their neighborhood, it is only temporary: 
if congenita], it is incurable. In other cases a caniculus 
is generally obstructed as well, which should hes/it open 
at once, and prevented from closing again, by passing 
for a few days occasionally a probe into it. Sometimes 
there is obstruction of the nasal duct in consequence 
of a thickening of its lining membrane, not uncommon 
in scrophulous persons, attended with a perpetual 
watering of one eye and dryness of the corresponding 
nostril. This is characterized by a small tumor by the 
side of the nose, which consists of the lachrymal sac 
distended with tears and pus, and the contents of which 
can be squeezed upward through the punta, and down 
ward into the nose if the obstruction is not quite com- 
plete. The best plan is to s/it open a caniculus and pass 
from there twice a week a style into the nasal duct (to 
be kept there half an hour) until the stricture is overcome. 

Dacryocystitis — Inflammation of the sac is known by 
redness, swelling and pain at the side of the nose, im- 
plicating the conjunctiva and eyelids, and attended with 
fever and headache. Treatment — If acute, leeches, co/cf 
compresses and cathartics (p. 88); if the pain becomes 
throbbing, the sac more and more distended, and its 
contents cannot be pressed down into the nose, the 
impediment within the nasal duct must be removed by 
catheterization as indicated. In the chronic form, an 
astringent (273) may be applied twice a day to the inner 
angle of the eye, to be transmitted to the sac by strong and 



230 Eye. 

repeated inspirations, with mouth and nose well closed. 

Fistula lachrymalis signifies a fistular opening at the 
inner corner of the eye, communicating with the lachry- 
mal sac, the ordinary consequence of an obstruction of 
the nasal duct, if not in time relieved. 

Synechia anterior et posterior consists of an adhesion 
of the iris to the cornea or capsule in consequence of 
organization of lymph from protracted iritis. Artificial 
pupil by iridectomy. In Atresia iridis, which is dependent 
on the same cause, iridectomy is also the only remedy. 

Myosis — Inability of pupil to dilate, attended with 
great obscurity in vision, and sometimes with injury to 
the sympathetic of the neck. Attention to general health 
and rest to the eye — Atropin does harm. 

Mydriasis — A preternatural dilatation of the pupil, 
which does not contract on exposure to light, caused by 
any injury of the brain affecting the tubercula quadri- 
gemina, as in apoplexy and compression, or on a derange- 
ment of the nerves supplying the iris, in which case it 
may be attended with ptosis — from paralysis of the third 
nerve; — or it may even depend on gastric irritation and 
general debility. It is often an attendant of confirmed 
amaurosis. Ergot or Strychn. (pp. 18 & 83), in conjunc- 
tion with blisters to the temples, are sometimes of use. 

Cataract (Grauer Staar of the Germans)— Opacity of 
the lens or of the capsule, or of both. Operation. 

Glaucoma — Choroiditis with diffuse imbibition by the 
vitreous body, which latter increases the intraocular 
pressure, terminating in disorganization and total blind- 
ness, is characterized by a stony hardness of the eyeball, 
a steamy looking cornea, and a dilated and fixed pupil. 
In the acute form — glaucoma fulminans — which occurs 



Vision. 23 L 

generally in feeble constitutions of elderly people, there 
is at the same time a violent neuralgic pain in the eye and 
throughout the ophthalmic branches of the fifth nerve. 
Treatment- -Next to rest, cold compresses, leeches and 
tapping of the anterior chamber. Iridectomy if chronic. 

Asthenopia or weakness of sight (muscce volitantes) r 
if dependent on hypermetropia, may be ameliorated by 
spectacles. If associated with intolerance of light, it is 
usually an accompaniment of short sight, easily recog- 
nized by the contracted brow and half closed, continu- 
ally winking eyelids. 

Amaurosis and Amblyopia— Blindness is often asso- 
ciated with some disease of the brain or spinal marrow 
— embolism of the central artery of the retina is a com- 
mon cause of blindness. Treatment — Pulsatilla (23), or 
Nux Vomica (p. 83) may be tried, and Strychn. or Veratrin 
(271 & 72) locally. Impaired vision, which may be a 
consequence of atrophy of the optic nerve, detached 
retina, retinitis, displacement of the lens, etc., is sejdom 
amenable to amelioration. 

Myopia — Short sight dependent on the fact that par- 
allel rays are brought to a focus before they reach the 
retina on account of either the refracting power of the 
eye being too great, or its antero-posterior axis too long. 
Use of carefully adjusted spectacles. Presbyopia or far- 
sightedness is called a narrowing of the range of accomo- 
dation, owing to changes in the lens and ciliary muscle. 

Hypermetropia is the converse of myopia: Parallel 
rays of light are not brought to a focus on the retina, 
but behind it, owing to the refracting power of the eye 
being too low, or the optic axis too short. It being one of 
the most common causes of asthenopia or impaired msion y 



232 Eye. 

and of convergent strabismus, it should be corrected by 
well selected convex spectacles. Astigmatismus (irre- 
gular refraction) — When different meridians of the same 
eye have different powers of refraction, characterized by 
the fact that whilst some lines or objects are seen clear, 
the neighboring ones look blurred. It may be owing 
to original conformation, cicatrized ulcers, or a conical 
condition of the cornea; or to disease or displacement 
of the lens. In Keratoconus, where the abnormal bulg- 
ing of the cornea causes first shortsightedness, but by 
degrees inability to see anything at all on account of 
too great refracting power, a concave glass or a perfor- 
ated diaphragm, or the two combined, will sometimes 
remedy the faulty refraction; but an artificial pupil by 
Jridodesis will be more satisfactory. 

Strabismus — ^Squinting signifies a want of parallelism 
in the position and motion of the two eyeballs. It is 
called convergent, when the affected eye is turned in- 
ward, which form occurs generally in young people, 
and is frequently due to hyperopia. When the eye is 
turned outward, as chiefly met with in elderly people 
(being due to a myopic condition or to partial paralysis 
of the internal rectus), it is called divergent. Moreover, 
squinting may result from congenital imperfection; it may 
be induced by using one eye constantly, or by imitating 
squinting persons. Sometimes it is a sequel of fever; 
and a disordered digestion, teething, worms, fright and 
fits of passion are known to give rise to it. Frequently 
it is caused by some disturbance in the brain, being 
often the precursor of acute hydrocephalus and convul- 
sions in children; and when it is accompanied by drop- 
ping of the eyelids, sleepiness, torpor of the intellect, or a 



Febrile Diseases. 233 

staggering gait, some mischief within the head may 
fairly be anticipated. Treatment — Squinting of not 
more than a few weeks duration may often be removed 
by a judicious management of the case, having for object 
the strengthening of the weak eye by exercise: Shutting 
up the sound one; wearing gogqles; placing black patches 
on the nose, etc. If the squinting is of long standing, 
the internal resp. external rectus must be divided to in- 
sure a cure, provided the antagonist be not paralyzed — 
if the disparity in vision is too great this operation will 
j t either be of lasting benefit. 

Fainting. See Syncope. 

Falling of Womb (Prolapsus uteri). See Uterus 
(Displacements). 

Ffbricula — An ephemeral form of simple or essent- 
ial fever, being not secondary to a local affection, but 
primary or idiopathic. It is associated with anorexia, 
constipation, headache, and more or less pain in the 
limbs, and lasts generally from one to three, seldom 
more, days. Treatment embraces refrigerants (p. 57); 
saline laxatives (p. 97); and, perhaps, anodynes (p. 20). 

Febrile Diseases — Local affections, attended with 
elevation of temperature and increased frequency of the 
heart's action — the so-called symp>toinatic fever. Treat- 
ment — Aconite or Veratrum (35 &S4); Nitre (pp. 55-57); 
Cinchonidin (p. 12), etc. 

Feet, sweating. See Ephidrosis. 

Fetor oris (Stomatodysodia). See Mouth. 

Fever. Bilious. See Fever (remittent). 

Fever. Continued. See Typhoid, Typhus, Relaps- 
ing and Erysipelatous fever 

Fever. Eruptive or Exanthematous. See Scar- 



234 • Fever, 

latina, Morbilli, Rubeola, Roseola, Varicelli and Variola 
— the latter for differential diagnosis. 

Fever. Essential — An idiopathic fever, character- 
ized by continuity or periodicity; or by specific erup- 
tions of the skin, constituting those general diseases 
known as continued, periodical and exanthemetous fevers. 

Fever. Gastric. See Gastritis. 

Fever. Hay. See Asthma. 

Fever. Hectic. An insidious fever, which accom- 
panies chronic disease, especially suppuration, and 
characterized by daily paroxysms of chills, followed by 
dry heat and sour perspiration, and a marked tendency 
to diarrhoea, leading sooner or later to emaciation. Treat- 
ment relates to the cause. Salicin (p. 18); Phosphor (154) ? 
land other tonics. 

Fever. Intermittent [Fever and Ague,, Swamp 
fever, the Snakes, etc.) — A periodical fever, due to a 
special morbific agent, known as malaria, and charact- 
erized by febrile paroxysms, which occur at definite in- 
tervals, thus constituting various types of the disease: 
The quotidian, if the paroxysm occurs every day — the 
tertian, if every other day — quartan, if every fourth day; 
and consisting generally of three distinct periods, a cold ? 
a hot, and a sweating stage, followed always by a per- 
fectly apyrexial interval. It is called pernicious, if it is 
associated with symptoms dangerous in themselves: In- 
tense jaundice — Icteric Iatennittents y hematuria or 
hemorrhage in other situations— IIe?norrhagic J. / vomit- 
ing and purging- Choleraic I.; cold extremities— Algid 7; 
restlessness and prostration — Asthenic I In the com- 
atose or apoplectic form the coma is sometimes preceded 
by delirium or convulsions. Treatment — Quinine (p. 11) 



Relapsing, 235 

directly after the paroxysm; if irritability of stomach, the 
tasteless tannate, especially in children — gr. v ter die to 
child of 3 years. Or it may be administered per anum 
or hypodermically (384 & 244). For rectal injections, 
the bisulfate, muriate or bromide are preferable to the 
sulfate on account of their greater solubility. In the 
hot stage, sponging (420). Of other remedies may be 
mentioned Acidum nitricum,Cedron (pp. 9 & 10); Salicin, 
Resorcin (pp. 1 4 & 1 6) ; Ammon.andTablesaltfpp. 44 & 96) ; 
Bebeeria, Cocaine, Cuprum (pp. 74-78); Phenol or Pilocar- 
pin hypoderm. (pp. 51, 107 & 110) — the latter injected 
before the paroxysm is said to prevent the same. In 
chronic intermittens, Arsenic (p. 10) is perhaps the best 
remedy — 0.C005 or one drop of Fowler's solution ter die 
may be safely given to a child of 3 years — but it must 
be used for some time. The pernicious form has to be 
treated symptomatically. Opium (p. 35) in restlessness, 
convulsions, diarrhoea, etc.; Chloroform (p. 81) to induce 
sleep; Camphora externally (409) in cold stage; brandy 
(p. 72), and other stimulants as support, if necessary. 
As the 'pernicious paroxysm is always preceded by at (east 
one devoid of danger, it is of importance to present 
another. Anaemia and general dropsy as sequel requires 
Ferrum (pp. 76 & 79). In enlargement of spleeii — ague 
cake, Quinine (pp. 1 1 & 76); Brom and Ergot (pp. 24 & 65, 
with Belladonna plaster (411), etc. 

Fever. Periodical. See Fever (Intermit lent, He- 
mittent, Typho-malarial and Yellow fever). 

Fever. Puerperal. See Puerperal fever. 

Fever. Relapsing (Typfais recurrens, Uunyer- / pe,st) 
A form of continued fever, contagious, and without a 
prodromic stage, characterized by sudden paroxysmg, 



236 Fever. 

which are ushered in by a chill, and may last from two 
to ten days, being separated by a thorough apyrexial 
period of a similar duration; frequently attended by 
nausea and vomiting, and above all, by muscular pains, 
which will continue during the intermission. The 
paroxysms are supposed to be due to broods of ' spirillce, 
as they terminate with their existence, and reappear 
with a fresh brood. Treatment — Aside from a milk 
diet, and, in asthenic cases, brandy (p. 72), sponging or 
the wet sheet (420), with salines (p. 96), and if neces- 
sary anodynes (p. 20). Afterward tonics (p. 76). 

Fever. Remittent — A periodical fever, dependent 
like intermittens on malaria, and characterized by dis- 
tinct remissions, which may take place at intervals cor- 
responding to those of apyrexia in the various types of 
the latter, and associated with gastric symptoms: nausea 
and vomiting, with some tenderness over the epigas- 
trium. Treatment essentially that of intermittens — 
sponging or the wet sheet (420), as in typhoid, if the 
skin is very hot and dry. The malignant form — Jangle 
fever — standing in the same relation to pernicious inter- 
mittens as the simple forms to each other, claims the 
treatment of that disease. 

Fever. Scarlet. See Scarlatina. 

Fever. Typho-malarial — Being as the name sug- 
gests, produced by the combined action of malaria poi- 
son and the especial cause of typhoid, it is also charact- 
erized by the symptoms of both of these diseases: 
Periodicity of fever, diarrhoea, tympanitis and iliac 
tenderness, connected with abdominal lesions, in con- 
junction with the ataxic series, as delirium, subsultus 
tendinum, etc., according to the proportions in which 



Fractures. 237 

they may stand to each other in the different cases. The 
treatment is, of course, anti-periodic and anti-typhoid. 

Fever. Yellow — An essential fever of a miasmatic- 
infectious nature, and peculiar to warm climates, where 
it occurs sporadically and epidemically. It is of more 
or less intensity, without a particular distinctive char- 
acter, generally ushered in abruptly by a chill, and last- 
ing from a few hours to three days — when, in mild cases, 
reconvalescence may take place —followed after a short 
time of comparative ease by black vomit, yellowness of 
skin, especially of the conjunctiva, hemorrhage, a notable 
fall of the pulse (sometimes to 30 p. minute), and all signs 
of collapse. The treatment is symptomatically: Aside 
from a milk with lime-water diet, sponging (420). In 
gastric irritability and vomiting, ice per os; sinapism to 
epigastrium, and internally Creosot (p. 64); Cyan or 
Chloroform (pp. 30-32), or Pilocarpin (pp. 51 & 110). 
Restlessness requires Opium (p. 35); hemorrhage, Ergot 
(p. 65); and prostration, brandy (p. 73) per anum, if not 
retained by the stomach. 

Fibroid. See Uterus. 

Final cessation of menses. See Menopause. 

Fissure of anus. See Anus. 

Ftstula. Fecal, urin ary and vaginal. See Vagina. 

Fit. See Convulsions. 

Flatulency. See Tympanitis. 

Flexions. See Uterus (displacements). 

Fluor albus. See Leucorrhcea. 

Fractures are solutions of continuity of a bone, as 
wounds are of the soft parts. A fracture is called simple 
when there is no wound communicating with it; com- 
pound, when there is such a wound; and complicated, 



238 Fractures. 

where there is laceration of an artery or joint, or other 
additional injury. Comminuted it is said to be if the 
bone is broken into more than two pieces at one place, 
multiple, if broken at different places, or more than one 
bone in the same limb. It is characterized by deformity, 
preternatural mobility and crepitus in conjunction with 
more or less pain, swelling and helplessness of the in- 
jured part, spasm of the muscles, and sometimes con- 
siderable subcutaneous ecchymosis. However, deform- 
ity may be absent in fracture of the ribs, pelvis and 
scapula, and the other signs are sometimes wanting in 
impacted fracture, or when the bones are held firmly by 
muscular spasm. Treatment — While the upper end of 
the limb is held steadily by one assistant, the lower is 
extended, i. e., firmly, gradually and gently drawn in such 
a direction as to restore the limb to the proper length 
and shape; the surgeon meanwhile manipulating with 
his fingers, and placing the fragments in their correct 
position. Chloroform (304) may, if necessary, be ad- 
ministered to prevent pain and spasm. Under con- 
tinued extension the whole of the fractured limb should 
then be bandaged from its extremity, for the purpose of 
preventing contraction of the muscles and swelling* 
Now, layers of wadding or old linen to fill up ail hollows 
may be applied, a strip of stout tape laid lengthwise on 
the limb, and the whole evenly covered with layers of 
bandages of old linen, well soaked in starch or dextrine. 
If the apparatus has to be got off or loosened (as in case 
of swelling), it may be lifted with the tape and easily 
ripped up by means of scissors as a complete mould, and 
without wounding the skin— if dampened with boiling 
water it can be softened and put on again more com- 



Gangrene. 239 

fortably, but sufficiently tight to keep the parts steadily 
in their place. (Plaster of Paris is also a good material). 
Wounds and doubtful bruises should be left uncovered, 
and every newly-set fracture, especially if done up in a 
circular bandage, should be examined after six hours: 
If the fingers or toes are blue or benumbed, there would 
he a possibility of gangrene. The remaining treatment 
must be conducted on general principles. Cordials 
(p, 72) to restore the patient from the shock of the in- 
jury; the- catheter — usually required after fracture of 
the leg; aperients (p. 88), cold lotions and leeches must 
" e employed at the discretion of the practitioner. Opium 
in grain doses 1-3 times a day, and if need be, with 
Colocynthis, may be given to allay pain and irritation. 
(For consolidation fractures require from 30-40 days. 

Freckles. See Skin. 

Fright. See Excitement. 

Frostbites. See Perniones. 

Furunculus (Boil) — A circumscribed, round and hard 
swelling from inflammation of true skin, attended with 
pain and tenderness, and ending in suppuration. It is 
caused by unwholesome food and depressing influences 
generally. For treatment see Carbuncle — Poultices wdth 
purgatives (p. 88); Napthol (21), and, perhaps, the knife. 
If indolent, Creosote, Opium, Iodine (398, *00 & 402). 

Gallstones. See Calculi (biliary). 

Gangrene — A mortification of tissue in consequence 
of inflammatory action or obstruction in the circulation, 
etc., accompanied by putrefaction ; or dependent on some 
constitutional cause, and the result of deficient supply of 
blood, etc., the dead part becoming dry and hard: This 
constitutes dry gangrene, whilst the former is called 



240 Gastralgia. 

humid or moist, the decomposed effusion being known 
as slough. Treatment according to causation, with local 
applications of Phenol, Brom (398); Chrom or Salicin 
(344 & 99); in hospital gangrene, 01. Terebinth, Creosote 
or Acidum nitricum (352 & 72). See Phagedena. For 
Pulmonary Gangrene see Lung. 

Gastralgia (Gastrodynia) — A neuralgic affection of 
the stomach, frequently associated with spasmodic con- 
tractions, so as to give the pains a griping character 
{colic), and accompanied sometimes by vomiting and 
dyspeptic symptoms. In the chronic form the pain 
occurs either in more or less frequent paroxysms; or it 
is continuous with occasional exacerbations. Treatment 
— Fomentations or a sinapism to epigastrium; and inter- 
nally, Belladonna, Brom or Hyoscyamus (pp. 22 & 23); 
Cyan (66) — Morphine is objectionable — Bismuth in large 
doses (p. 46); Spir. cethereus or brandy; Nux Vomica or 
Pepsin (pp. 83 & 84); Alum (p. 63); Arsenic and Quinine 
(pp. 9 & 11); A rgentum (p. 74), etc. SeeColicaintestinalis. 

Gastritis — Gastric Catarrh, if accompanied with 
considerable pyrexia, Gastric Fever is called an inflam. 
mation of the stomach, caused mostly by abuse of alco- 
hol and dietetic excesses, and characterized by distress- 
ing pain in the epigastric region, which is increased on 
pressure; nausea and vomiting; intense thirst; and, 
unless the consequence of irritant poison, constipation. 
In acrid poisoning there is generally diarrhoea, vomiting 
of bloody matter, and burning pain in mouth, fauces and 
oesophagus. Treatment — Aside from fomentations, tur- 
pentine stupes or sinapisms to epigastrium, Morphine at 
once (77 & 255); ice to allay the thirst, and milk with 
Aq. Calcis as diet. Emetics and cathartics are contra- 



Gastritis. 241 

indicated; instead of the latter, enemata (385 & 86), if 
necessary. In the toxical form emetics or the stomach- 
pump to commence with; then, to neutralize the poison, 
the appropriate antidote. In poisoning from an acid 
emetics are of no use. In subacute gastritis (bilious attack) 
there exists sometimes irresistible desire to provoke 
vomiting by voluntary efforts on account of a secretion 
in the otherwise empty stomach, very much like that 
known as tenesmus, and produced by the particular form 
of inflammation. In the chronic form, nausea and vom- 
iting, with anorexia and habitual thirst is more likely to 
occur than in functional disease; but still more char- 
acteristic is the tenderness in the epigastric region, which 
is here continuous, and not only during digestion as in 
dyspepsia. Chronic gastritis moreover results frequently 
from long continued nervous congestion of the stomach, 
caused by obstacles to the circulation in the liver, lungs 
and heart; and it is also present in certain cases of renal 
disease, because the carb. of ammonia, which is formed 
from the decomposition of urea, acts as a local irritant, 
when eliminated by the gastric mucosa. Treatment — 
Aside from a diet consisting of articles which are 
digested in the small intestines — neither meat nor stimu- 
li nts must he allowed — Cyan or Opium may be given 
(p. 35); or Hyoscyamus, Arsenic, Argentum,Ammon. (p. 44); 
Tannin or Creosote (pp. 62 & 64); if vomiting of glazing 
matter. Alum, Hydrastis (p. 82), if from drink; and in 
atony or debility after the acute symptoms have passed, 
Nux Vomica and acids (pp. 61 & 71). See Dyspepsia. 

Gastric Ulcer. See Stomach. 

Gastro-intestinal Catarrh. See Enteritis. 

Gastrodynia. See Gastralgia. 



243 Globus hystericus. 

Gastrorrkagia (Gastrorrhoea). See Hemorrhage 
(from stomach). 

Gestation. See Pregnancy. 

Gingivitis parenchymatosa [Stomatitis ulcerosa). 
See Mouth. 

Glands. See Lymphatics. 

Gleet. See Gonorrhoea. 

Globus hystericus — The result of primary irritation 
of the uterine nerves, which is transmitted through the 
whole chain of ganglia to the nerves of the oesophagus 
and trachea, producing here spasm. See Hysteria. 

Glossitis. See Mouth. 

Glottis. (Edema. See Larynx. 

Goitre. See Bronchocele. 

Gonorrhoea (Urethritis) — A suppurative inflamma- 
tion of the mucosa of the genitals, produced occasion- 
ally by gout — if attended with acid and irritating 
urine) — and several other irritants; but generally it 
is due to contagion from matter of a mucous mem- 
brane in a similar condition, and characterized by 
a purulent discharge, scalding urine, and sometimes 
chordee (a painful crooked state of the penis during 
erection). It may be complicated with balanitis (a sup- 
purative inflammation of the mucosa covering the glans), 
hemorrhage from the urethra, bubo, phimosis, orchitis, 
etc., and in severe cases the inflammation may reach the 
bladder, and cause even irritation of the kidneys. Treat- 
ment according to cause. In the acute stage, saline 
cathartics (p. 69); Aconite or Nitre (35 & 122); if ardo 
urinm, Potass, (p. 54). Afterward Copaiva (106) in con- 
junction with injections of Zinc, Plumbum, etc (32 7, 333-36). 
If chordee, Camphora or Cocaine (54 & 330). If balan- 



Hematocele. • 243 

itis,ra/7/7/7;,etc.(396). A catheter dipped in carbolic 0/7(39 8) 
and passed into the urethra about one inch a-half every 
hour for five hours, is said to abort incipient gonorrhoea. 
In the chronic form — gleet, tonics (pp. 69 & 10); Col- 
chicum, Uva Ursi (105 & 151), and injections of Bismuth 
r Zinc (326 & 336); if complicated with spermatorrhoea, 
Ferrum (143). Gonorrhoea in females requires a similar 
treatment. See Vaginitis. 

Gout. See Arthritis. 

Gravel. See Urinary Deposits. 

Growths. See Tumors and Carcinoma; Polypus in 
'0 — Hemorrhage (from the uterus); other uterine 
growths — Uterus. 

Gumboil (Parulis) and spongy gums. See Mouth. 

ILematemesis. See Hemorrhage (from the stomach). 

Hematocele. Retro-uterine — An extravasation of 
)d in thefossa^between the uterus and intestines, accom- 
| nied by a severe pain in the back passage, and frequent 
desire to defecate. (It must be discriminated from a 
retroverted or prolapsed uterus). Treatment — Aside 
from an enema of Aqua tepida (Oj) every night, to 
keep the bowels in a soluble state, the absorption of 
the blood may be assisted by occasionally puncturing 
the tumor, to allow the escape of a little blood, with a 
needle per vaginam. For the relief of pain Morphine 
(255). Pudendal Hematocele, which is generally con- 
nected with pregnancy or parturition, and which con- 
sists in a mass of blood, effused into the tissue of a 
labium, or the areolar tissue, surrounding the wall of the 
vagina, associated with a throbbing pain and difficulty 
of walking, may be treated with a cooling lotion (337). 
This, in conjunction with rest, will frequently suffice to 



244 Hcematocele. 

produce absorption of the thrombus; but if there is evi- 
dence of plegmonous inflammation, suppuration should 
be encouraged by poultices (see Vulva). If the tumor be 
large, an incision by means of a bistoury should be made 
upon the mucous surface of the labium, the clot turned 
out of its nidus, and the cavity washed with phenol- 
water (398), to prevent phlegmonous inflammation or 
septicaemia. In case of hemorrhage the cavity must be 
washed with Fern, persulf. (366 & 67), or pledgets of 
lint soaked in this astringent may be pressed into the 
sac, and if necessary counter- pressure per vaginam, by 
means of a cotton tampon. 

Pelvic Hcematocele or Periuterine Hematoma consists 
of an accumulation of blood in the pelvic cavity, either 
above or below the peritoneum, in consequence of sudden 
stoppage of the molimia; obstruction of the cervical 
canal or Fallopian tubes; excessive coition; violent 
efforts; blows or falls, and the like, and is accompanied 
by great prostration : Pallor and faintness, nausea and 
vomiting, coldness of extremities, metrorrhagia with 
uterine tenesmus, in conjunction with a severe pain and 
a sensation as if a large and heavy body existed in 
the pelvis, which the patient instinctively strives to expel 
through the vagina. The reaction, which occurs within 
4 8 hours, according to the degree of inflammation set 
up by the sanguinous accummulation, is marked usually 
by a tendency to chilliness, suppression of urine, and 
constipation, tympanitis, heat of body, and small but 
rapid pulse, pointing both to a sudden and excessive loss 
of blood, and to the existence of some substance in the 
pelvis, which mechanically interferes with the viscera. 
Vaginal touch will reveal a soft tumor, mostly posterior 



Haemoglobin uria* 2 4 5 

to uterus and vagina, and generally partially closing the 
latter, and according to the quantity of the effused blood, 
or whether it has collected in the peritoneum or in the 
areolar tissue beneath it, an abdominal tumor may be felt 
as high up as the navel, or may not be discovered at all ; 
but care should be taken not to confound it with pelvic 
cellulitis or abscess. Treatment — Aside from cold com- 
presses or an ice bladder to hypogastrium* Acid. sulf. 
arom. or Acid. gall. (p. 61) in free doses, with cold drinks, 
especially iced champagne or brandy and water. In great 
nervous prostration Opium (255), this being a more re- 
liable stimulant than alcohol,- having moreover the ad van t- 
eige of relieving pain — see Hemorrhage from abortion. 
As long as nature seems to be causing the absorption of 
the tumor, it should be left alone; however, if there are 
signs of septicaemia — chills, febrile action and profuse 
sweating — the softening mass should be discharged by 
incision. After evacuation, the patient should not rise 
from bed, even for calls of nature, the bladder being 
emptied by the catheter — the bowels have to be kept 
constipated by Opium. Besides poultices to hypogas- 
trium, and after abatement of acute symptoms, a blister, 
if necessary. Perfect rest is imperative. 

Hematuria. See Hemorrhage (from the urethra). 

Hemoglobinuria (Hmraatinuria) — Intermittent or 
paroxysmal hematuria is a hemic affection, characterized 
by an attack of chilliness, followed by more or less fever, 
and associated with the elimination of hemoglobin by 
the kidneys, the blood-corpuscles having previously 
undergone a kind of dissolution. The affection is sup- 
posed to be due to exposure to cold. Treatment — Brandy 
and tonics (p. 69), in conjunction with warmth. 



246 Haemorrhoids . 

ILemometra. See Uterus (Imperforate Os). 

Haemoptysis. See Hemorrhage (from the lungs). 

Haemorrhoids — Piles are small, indolent or inflamed 
tumors, near or within the anus, and consist of en- 
larged and knotted veins, covered with mucous mem- 
brane in various stages of congestion, and generally 
connected with a sluggish circulation in the abdominal 
veins and torpor of the bowels. They cause much dis- 
comfort, and more or less pain in defecation; frequent- 
ly irritation of the bladder; and in women uterine irri- 
tation with mucous discharge, when inflamed, they will 
not only produce violent straining and prolapse, but oc- 
casionally much hemorrhage. Treatment — Hot fomen- 
tations, or cold lotions, leeches if necessary. After- 
wards Opium, Iodoform or Hyoscyamus (337 & 373), in 
conjunction with cathartics (pp. 89 & 97). If bleeding, 
Alum (p. 63). Within the anus, they may be destroyed 
by cauterization with Acid, nitric, v. carbol. (372), unless 
they are actual tumors or a large tract of mucous mem- 
brane, when the ligature is the proper remedy, as 
excision is of external piles. 

Hair— Of the many remedies which are recommend- 
ed for its growth, may be mentioned Bals. peruvian. and 
brandy (388 & 89) — see Head. To remove superfluous 
hair, Cafe. (338) maybe used, but electrolysis (p. 149) is 
preferable, (It is of importance that a strong light be 
directed on the surface to be operated upon, and that 
the latter be on a level with the operator's eyes). 

Hayasthma. See Asthma. 

Head — Pityriasis is a local disease, confined to the 
head, which consists of irregular patches of a furfura- 
ceous or scaly nature. Treatment is local: Citrine oint- 



Head. 247 

ment, Borax (390) etc.. That form occurring in phthis- 
ical subjects seldom requires treatment, For Pityriasis 
versicolor see Skin (Parasitic Moles). 

Tinea Capitis or Porrigo is an eczema affecting the 
scalp and frequently the face (in the latter case it is 
called crusta laciea). Cuprum, Zinc, or Mercury (391). 

Tinea Favns — Scaldhead also known as Porrigo is 
a parasitic head disease consisting of cup-shaped scales, 
which requires the same remedies, after having removed 
the scab by softening it with poultices and fat. 

Tinea tonsurans , Porrigo s. Herpes tonsurans consists 
in an erythematous inflammation of a circular form, ac- 
companied by itching, and soon followed by a white, 
powderlike fungus (Trichophyton) , which covers the 
epidermis between the single hairs, making them dry 
and brittle, so as easily to break. (If the same parasite 
forms on parts covered by lanugo, the disease is called 
Dermatomy costs seu Trichophytosis tonsurans (Ring- 
worm), and if it forms under a nail, making it knotty 
or brittle, the disease is called Onychomycosis tonsu- 
rans. Treatment — Iodine (p. 15) or Mercury (390 & 92) 
with or without epilation. Tinea pelada or Area 
Celsi is a form of alopecia, where lotions of Ferrum and 
Jaborandi (3S8) may be of service. In baldness [Alo- 
pecia acquisita or calviti'es) a whig will be the remedy. 

Tinea Mycosis or Mentagra — The so-called Barber's 
Itch, is a simple inflammation of the hair follicles char- 
acterized by papules and vesicles. When due to a fun- 
gus, it is called trichomycosis. Treatment -The loose 
hairs should be removed by means of the epilating for- 
ceps (as long as they are firm in the follicles, epilation 
does no good), afterwards Mercury or Phenol (392 &98)* 



248 Heart. 

Headache. See Cephalalgia. 

Heart. Pericarditis — Inflammation of the serous 
cover of the heart, unless due to trauma, is mostly de- 
veloped in articular rheumatism, pleurisy, and Bright' s 
disease. It is characterized by increased action of the 
heart: quick, vibrating pulse, with pyrexia and its 
concomitants — anorexia, debility, etc., more or less 
pain in the prsecordia, and a dry irritable cough, in con- 
junction with those symptoms arising from the co-ex- 
isting affection. Almost pathognomic is the cardiac 
friction murmur — an adventitious sound, caused by 
friction of the pericardial surfaces in the movements 
of the heart — which may be heard at an early period, 
as exudation usually takes place within a few hours af- 
ter the commencement of inflammation. It is of a 
grating or creaking nature^ generally double and not 
propagated beyond the borders of the heart; it may 
even be limited to a portion of the precordial space. 

The existence of effusion maj be determined by per- 
cussion, and the size and shape of the area of abnorm- 
al dulness, within which vocal resonance and fremitus 
are diminished or lost, will be in proportion to the 
amount of the liquid. Moreover the apex-beat of the 
heart is weakened or suppressed, and its situation may 
be altered as well. Treatment — Poultices or cold com- 
presses to prsecordia, with Aconite (p. 22) internally, 
and due attention to the causative disease. Opium 
(p. 35) to relieve pain; Digitalis (pp. 50 & 96), if effu- 
sion; and in second stage brandy (p. 72), as support. 
In the chronic form, salines (p. 96) and tonics (p. 69), 
with Iodine (413) or blisters locally. 

Endocarditis — Inflammation of the membrane, lining 



Valvular Lesions. 249 

the cavities of the heart, is like pericarditis mostly con- 
nected with articular rheumatism and Bright'* disease; 
and as endo-pericarditis it occurs occasionally in erup- 
tive and continued fevers. It is characterized by pal- 
pitation, the heart's action being frequently out of pro- 
portion to the force of the pulse; and the precordial 
pain, if present, is but dull, not sharp and lancinating 
like that in pericarditis and pleuritis. The endocar- 
dial or belloics murmur is systolic and consequently 
more regular in rhythm than the pericardial murmur. 
(As this murmur may proceed from valv. lesions, its 
existence or non-existence should be ascertained prior 
to the rheumatic attack). Treatment — Aside from sina- 
pisms and stimulating liniments to pnecordia (409), 
alkalies (p. 54) internally — to prevent fibrinous depos- 
its in rheumatism. If restlessness, Chloral (60) etc. 

Myocarditis — Inflammation of the muscular struct- 
ure is either interstitial and chronic, or suppurative. As 
it is impossible to diagnosticate the different myocard 
ial lesions the treatment can be but symptomatic. 

Yalmdar Lesions, unless congenital, affect nearly 
always the mitral and aortic orifice; and though some- 
times syphilis may be traced as a remote cause, they 
are generally due to chronic endocarditis, whether they 
be of an obstructive nature — contraction or stenosis of 
the ostia; or regurgitant — insufficiency of the valves; or 
both. Sooner or later they lead to hypertrophy and 
dilatation, which generally coexist, followed ultimately 
by general dropsy, beginning with anasarca of the lower 
limbs. Mitral lesions, before having led to hypertrophy, 
do not occasion inconvenience, then deficiency of breath 
xercise is the first symptom, and increases in pro- 



250 Heart. 

portion as the obstruction to the pulmonary circulation 
increases, until dyspnoea becomes habitual, culminating 
in orthopnoea, the patient being unable to lie down. 
Aortic lesions are attended more by palpitation, espec- 
ially on mental emotions or exercise, and a precordial 
pain, irrespective of angina pectoris. Whilst mitral 
lesions are characterized by a systolic or presystolic mur- 
mur, to be heard best near the apex-beat, the systolic 
murmur produced by aortic lesions (generally propaga- 
ted with the carotids), is most distinct at the base of 
the heart. The latter must not be confounded with 
the anaemic or hcemic murmur, which is inorganic, be- 
ing due to anaemia, and known by its varying intens- 
ity — sometimes it even disappears altogether/ though 
mostly it is connected with the venous hum ofthejugu- 
laris. The tricuspid murmur is best heard at the right 
inferior border of the heart, near the ensiform cartilage; 
and the pulmonic murmur, indicating pulmonic les- 
ions (iinless ancemic) at the base of the heart, over the 
pulmonary artery, in the second intercostal space, near 
the left margin of the sternum. The extent and grav- 
ity of the lesion may be ascertained by comparing the 
diastolic murmurs as produced separately at the aortic 
and pulmonary orifice — in the second intercostal space 
right and left to the sternum, and by the degree of hy- 
pertrophy, which is proportionate to the amount and 
duration of the obstruction and regurgitation caused by 
the lesion. Treatment — Aside from good nourishment 
to retard the progress of dilatation, Digitalis (1 Vl), if 
the heart's action is irregular and feeble from dilatation 
—not where hypertrophy predominates; it is especially 
useful in hypertrophy from mitral regurgitant lesions. 



Hypertrophy, 251 

Aconite (p. 22), if the action of the heart is rapid, but 
not weakened by dilatation; and in cases where func- 
tional disorder is superadded, a brisk hydragogue (205) 
from time to time for the relief of dyspnoea; or Ether 
(304) or Ammonia', or dry cups to chest. Ammonium 
with Senega (pp. 43 & 73) in aortic regurgitation and 
Iodine, or a Belladonna plaster to praecordia (411 & 13). 
Sedatives (pp. 23-33) are sometimes of service. Lobelia 
(75) is occasionally used. Nux Vomica (p. 83), or Cof- 
feine (p. 75) may also be tried; or brandy (p. 72) as stim- 
ulant, if required. Ancemia should be treated, since irreg- 
ular or excessive action of the heart, dyspnoea, and even 
dropsy may be due to the superadded functional disorder. 
Hypertrophy and Dilatation — The former is an abnor- 
mal increase of the muscular substance, being called 
simple, if the capacity of the cavities is of normal 
size; and eccentric, if it is enlarged, i. e. dilated. The lat- 
ter is an abnormal enlargement of the cavities, called 
simple, if the muscular wall is of normal thickness; and 
hypertrophic or atrophic, if it is thicker or thinner than 
normal. Hypertrophy and dilatation, if primary, may 
be produced by habitual over-exertion of the muscular 
system, and by repeated nervous excitement of the 
heart; but mostly they are due to some mechanical ob- 
stacle to the circulation, which may be situated in the 
heart itself — valvul. lesions, etc., in the pulmonic — em- 
physema, pleuritic effusions, etc.; or in the- systemic 
circulation — atheroma, small, granular kidney, etc. In 
proportion as the apex is removed without the left nip- 
ple, and lowered, is the amount of enlargement: The 
left border of the heart is found by percussion to fall 
from one to three inches without the left nipple, the sit- 



252 Heart. 

nation of the right border and the base of the heart be- 
ing generally but little changed. If the first sound is 
loud, prolonged and booming, the apex-beat be felt by 
the hand to be abnormally strong, especially if there be 
a heaving elevation of the prsecordia with the vertricu- 
lar systole, hypertrophy predominates ; but if the first 
sound is weak, short and valvular, and the beating, if 
felt at all, feeble, dilatation is in excess. Treatment is 
not required in hypertrophy when compensatory; other- 
wise the excessive action of the heart must be modera- 
ted by aperients {p. 96), Aconite (35); Bell., Cyan (43 
& 68), etc. Dilatation has to be treated as in connec- 
tion with valv. lesions. Digitalis, Ergot, Ferrum (pp. 78 
& 79); Cimicifuga (p. 47); Am/1 (37); etc. 

Fatty Degeneration or Obesity — The metamorphosis 
of the muscular substance into fibrinous particles and 
fat, which in most cases is due to immoderate use of 
spirits and indolent habits, is characterized by more or 
less feebleness of the circulation, the pulse being irreg- 
ular and intermittent (its number falling sometimes as 
low as 20 p. minute), with dyspnoea, occasional fits of 
syncope or angina pectoris. Treatment — Aside from 
•-animal food as diet, with the exclusion of fat, mineral 
acids, Ferrum c. Chinino (p. 71); Cyan; and in irregu- 
lar action of the heart, Digitalis. Alcoholic stimulants 
/p. 72) in syncope or pseudo-apoplexy. 

Palpitation — A disturbed action of the heart, which, 
unless connected with organic disease, may be due to 
good living, excessive venery, dyspepsia, etc., but it is 
more frequently produced by anaemia and generally char- 
acterized by a higher degree of mental depression and 
anxiety than that caused by lesions. Treatment according 



Helminthiasis. 253 

to cause — In full habit or constipation, Aloes, Rhamnus 
7 & 215); or Mercury (p. 93); if there is amenor- 
rhcea, Acidum sulfuricum (136 & 155), etc. During the 
paroxysm, aside from ice bag, Belladonna plaster ', sin- 
apisms, or stimulating embrocations (409 & 1 1) to prsecor- 
dia, ethereal stimulants and antispasmodics — a mouthful 
of undiluted brandy; Camphora, Brom, Bell., Chloroform 
(pp. 24-30); Cyan or Zinc (68 & 195); or Cocaine 
(p. 77), Aconite (35), if action strong; Digitalis (68 & 
171), if feeble or irregular. 

Heartburn (Cardial gia). See Dyspepsia. 

Hectic Fever. See Fever. 

Helminthiasis — The name embraces a variety of 
diseases, produced by certain entozoa, which infest the 
human body, the larger number of these parasites be- 
ing developed in the intestines. 

Asearides lumbricoides — Round worms, which re- 
semble common earth-worms, inhabit the small intes- 
tines, emigrate sometimes into the stomach, and will 
even ascend the oesophagus. They are occasionally 
present in immense numbers; but the symptoms they 
produce are often so obscure, that their appearance is 
the only pathognomic sign of their existence. Impaii- 
ment of the digestive organs, together with a general 
cachexy are among the most frequent causes; and they, 
on the other hand, may occasion no disturbance what- 
ever, or they may give rise to the most extraordinary 
symptoms, especially of a nervous nature, as aphony, 
catalepsy, epilepsy, even paralysis. Treatment — The 
chief remedies are Santonin and Spigelia (p. 103). 

Oxywis vermicular is — Pin or thread worms which in- 
fest the rectum, and sometimes are voided in large masses, 



254 Helm hit It iasis . 

agglomorated by mucus, produce generally pruritus aoi, 
and in girls pruritus vulvae with leucorrhcea from mi- 
gration into the vagina. Excitation of the sexual organs 
leading to masturbation is frequently a sequel; but 
general debility, even in adults, is by no means rare. 
Treatment — Enemata of Acetum or Ferrum; or suppos- 
itories of Ungt. Hydr. nitr. (376 & 77). 

Toenia solium— The tapeworm is a flattened animal, 
composed of numerous segments, and attaining to such a 
length, that it will often occupy the intestinum crassum, 
for want of room in the small intestines, which are its 
real habitat. (T. mediocanellata, and T. lata, are also 
tapeworms, met with in the human body; however their 
discrimination is of no practical value). The symptoms 
tapeworms produce, are as obscure as those of the round 
worms — sometimes of no significance whatever, some- 
times as severe, as they are varied. Aside from colic- 
pains, emaciation, and other disorders of the digestive 
system, a tapeworm is supposed to cause the most seri- 
ous disturbances of a nervous nature, as vertigo, tinni- 
tus aurium, temporary amaurosis, epilepsy, etc., etc, 
Treatment — Aspidium, Phenol, Thymol, etc. (pp. 103-5). 
Cuprum has been recommended as a specific. . People 
who do not like to fast, may have pumpkin pie for 24 
hours as diet, to facilitate the removal. 

Hemiplegia — Loss of motion, with or without loss of 
sensation, affecting one or more muscles on one side of 
the body. Unless due to cerebral lesions, it is a func- 
tional disease of the nerves, following sometimes diph- 
theria, epilepsy, and chorea; but most frequently con- 
nected with hysteria — see Paraplegia. Hemiplegia fa- 
cialis, if peripheral, is generally produced by injury to 



Hemorrhage. 255 

the seventh pair of nerves; occasionally it is due to cold. 
Treatment — Nux Vomica, Phosphor (pp. 83 & 86), or elec- 
tricity (p. 148) are the chief remedies. If from undue 
pressure of the forceps in infants, Linimentum vel Oleum 
camphoratum as embrocation. 

Hemorrhage, if active, is the escape of blood through 
the walls of the vessels or the heart, and mostly due to 
inflammation or excitement — if passive, it is caused by 
the obstruction to the return of venous blood, or it 
may be owing to structural weakness of the blood ves- 
sels, etc., etc. Aside from a treatment having refer- 
ence to the disease, with which the hemorrhage is con- 
nected as a symptom, the indications for its arrest are 
in all forms essentially the same. Irrespective of bleed- 
ing from any part of the surface of the body, as pro- 
duced by injury (see wounds), leech bites, and similar 
cases where pressure, Boletus igniarius, Alum, Vinegar or 
cobweb will suffice, the indications are: Rest in the re- 
cumbent position, with ice or cold water compresses 
locally; and internally, besides Opium (p. 35), haemosta- 
tics — Acid urn gallicum, tannicum, or sulfuricum ; Alum; 
Ergot; Ferrum and Plumbum (pp. 61-67). 

Epistaxis — Hemorrhage from the nose may be due to 
simple determination of blood to the head; but it is 
most frequently incidental to some general disease, as 
to obstruction to the circulation in cases of heart and 
liver affections; it may be even vicarious of menstrua- 
tion like haemoptysis. Treatment — Astringents or cold 
water by irrigation or atomizer. In urgent cases, plugg - 
ing: A curved catheter (if the proper intrument be 
not at band) may be used for the purpose of plugging 
the posterior orifice of the nostril; in the anterior nares 



256 Hemorrhage. 

a fold of lint may easily be inserted by means of a 
probe. The plug has to be left for three days. 

Ucernoptysis — Hemorrhage from the lungs, which is 
called Pneumorrhagia, if the blood proceeds from the 
parenchym of the lungs, and JBronc/iorrhoea, if the 
affected part is the bronchial mucous membrane, is 
incidental to various diseases of the lungs and heart, 
aneurisms, etc.; though it is often vicarious of menstru- 
ation, and may occur even idiopathically. In addition 
to the treatment indicated above, inhalations of Alum or 
Ferrum (305 & 20); Tablesalt in half drachm doses or 
in solution, by spoonsful, occasionally, until nausea, is 
sometimes of service; or temporary ligation to the ex- 
tremities for the purpose of retarding the flow of blood 
to the heart. 

Gastrorrhagia and Enter orrhagia — Hemorrhage from 
the stomach and bowels, the former if vomited, being 
called IIwmatemesis\ though the blood may also be 
evacuated by the bowels, like the latter, which has its 
origin in the intestines. Both, intestinal and gastric 
hemorrhage, are generally connected with morbid con- 
ditions, though they may arise from portal congestion, 
or be vicarious of menstruation. Treatment — Besides 
the indicated remedies, Creosote or Terebinth, (pp. 64 
& 67) may be tried. Opium may also be given to 
quieten the nerves and prevent peristalsis, and food 
and drink should be taken cold. — Hemorrhage from 
the rectum is generally caused by bleeding piles within, 
and may be treated with astringent lotions, etc., unless a 
radical cure by operation be preferred. 

Hematuria — Hemorrhage from the urethra may have 
its origin, either in the urethra, bladder, ureters, or kid- 



Metrorrhagia . 26 7 

neys. In urethral hemorrhage, the blood escapes with- 
out any effort at micturition. In cystic, there is gener- 
ally obstruction to the free passage of urine, and the 
blood follows as a rule the discharge of the latter. It 
is caused by a disordered state of the bladder, but may 
be also produced by the pressure of a calculus, a wound, 
and by injury. In hemorrhage from the ureter, which 
may be distinguished by the presence of fibrinous casts 
in the urine, a calculus is always the cause; and renal 
hemorrhage is either a symptom of kidney disease, or it 
occurs like cystic hemorrhage alone or conjointly in 
diseases of a hemorrhagicdiathesis, as scorbut, yellow f ev 
er, etc. (For Paroxysmal or Intermittent Hmmaturia see 
Hemoglobinuria). Treatment — Aside from Acid, gallic, 
Ergot and Terebinth.; Lith. benz. (p.50), is recommended. 

Pudendal hemorrhage is the consequence of a rupture 
of the bulbi vestibuli, a reticulated plexus of large veins 
beneath the labia, provided there be rupture of the skin 
at the same time (see Hematocele), which, irrespective 
of injury, may be caused by great muscular efforts, if 
the veins are in a varicose condition, especially during , 
pregnancy. Treatment— If the flow of blood cannot 
be controlled by cold and astringents (341 & 367), 
the vagina should be filled with a firm tampon of cot- 
ton, a folded towel applied as a compress over the vulva, 
and a T shaped bandage made to press this forcibly 
against the body. 

Metrorrhagia — Hemorrhage from the uterus, if occurr- 
ing at the menstrual period, called Menorrhagia, is 
caused by any condition, which induces a state of active 
or passive congestion of the uterus, as areolar hyperpla- 
sia, subinvolution, displacements, etc.; it may be due 



258 Hemorrhage. 

however to granular degeneration, and whatever pro- 
duces a solution of continuity of the mucous membrane; 
or to some growth, which has a vascular connection 
with the uterine vessels, as polyps; or to a dyscrasia of 
the blood, as chlorosis; even general plethora may be 
the cause. Treatment — The immediate indications, as 
a rule are: Recumbent position in a bedstead (the foot 
of which might be elevated about ten inches); and cold 
compresses over abdomen, vulva and thighs, with ice, 
genera/ haemostatics and Opium internally. In severe 
cases the speculum must be introduced and the vagina 
filled with a tampon of cotton (369), medicated or no; 
and if danger imminent, injections into the cavity of the 
uterus have to be made after dilatation of the cervix, with 
Iron or Iodine (367). An examination during syncope is 
not admissible, because the flooding, tohich generally stops 
during that time, would be sure to be brought on again. 
The curative treatment will be according to the cause. 
If due to fecal impaction or active congestion and ple- 
thora, aside from acids with Ergot, Tannin or Ratanha, 
salines (p. 95) every morning; Calomel (p. 93); or a ni- 
tric acid issue either in the arm or on the side of the 
spine. If from debility, as caused e. g. by undue lac- 
tation; mental depression (grief); or from chronic en- 
gorgement at menopause (passive congestion), an enema 
of half a pint of cold water bis die, commencing after men- 
struation has begun; or Calomel followed by tonics — 
Quinine (165), as the case may be, and irrespective of 
acids, Ergot, Cannabis or Erigeron (pp. 28 & 61-66). In 
spasmodic menorrhagia, with or without chronic ovaritis, 
Brom (50); Ipecacuanha (140); Sabina (192); or Viburn- 
um (p. 39). If there be anaemia or nervousness, barring 



Uterine. 259 

Opium with enemata of cold water at night, Sabina or 
Cantharis (164); followed by Quinine and Phosphor (194). 
In hyperplasia, styled vegetations, or in fungoid degen- 
:!on — a consequence of a complication of subinvolu- 
tion or as a result of chronic engorgement of the mucous 
lining of the womb, the whole organ should be scraped 
with a wire -curette, after having dilated the cervical 

I with a tent, if necessary (p. 130). (After labor, 
especially after abortion, little growths, w r hich probably 
arise from minute particles of placenta having become 
organized, are sometimes found to be attached just above 
the os internum — with their removal by the curette the 
hemorrhage will cease at once). In simple subinvolu- 
tion Ergot alone will generally effect a cure. The same 
drug acts also curative after removal of hydatids or 
polyps, if they have been the cause. If the hemorrhage, 
produced by the former, be profuse, and the os uteri 

and dilatable, they may be extracted with the hand, 
taking care to remove the whole mass, else Tinct. Er~ 
gotce 3 j every 15 min.; or a piece of ice may be intro- 

d into the vagina and carried up to the cervix — an 
iciection of cold water against the mouth of the womb, 
or into the rectum will sometimes answer the same pur- 
pose. Whilst in the first case the stimulus of the hand 
will produce contractions of the uterus, and stop the 
bleeding, the stimulus of the action of cold will cause 
the motor nerves of the womb to contract, having been 
transferred from the excitor nerves of the vagina to the 
spinal cord — see Uterus). Should the hemorrhage be 
alarming, a tampon-, and internally Acid. sulf. etc. In 
carcinoma, the same treatment — Acid. gall, with local ap- 

nions of Alum, Tannin, Zinc, or Iron. (341 & 66); 



260 Hemorrhage. 

JPost-partum hemorrhage, whether the placenta be wholly 
or only partially detached, the hand should be introduced 
into the womb without delay, and with the dorsum of 
the fingers uniformly but gently pressed against its bleed- 
ing surface, whilst tvith the other hand counter-pressure is 
made on the abdominal wall. Should the womb not con- 
tract at once, recourse may be had to the cold douche. 
Throw a pitcher or two of ice water from a height of 
about two feet suddenly npon the abdomen, and the 
womb is sure to contract. Afterwards warmth to the 
patient should be restored by applying bottles with hot 
water, warm flannel, etc., without however removing her, 
as the slightest exertion on her part might produce syn- 
cope. Or hot water (110°-120°) with Phenol (228) — 
to prevent septicemia — may be injected into the uterus, 
and tape-ligatures placed round arms and legs, just 
tight enough to prevent venous circulation. Besides 
Ergot (109), which, with ice water as drink, and put- 
ting the child to the breast may in slight cases already 
suffice. If there be already great prostration — no pulse, 
cold extremities, etc., one drachm of Laudanum every 
10 to 15 min. until the pulse reappears at the radial ar- 
tery, together with warmth to the body and extremi- 
ties. If much thirst quick pulse, difficulty in breathing, 
etc., which indicate internal hemorrhage, also Opium in 
large doses with brandy. 

Post-partum secondary hemorrhage, if slight, requires 
Ergot in small doses; in severe cases, Sol. Ferri persulf. 
vel perch/or., just strong enough to produce a styptic im- 
pression upon the tongue, may be injected warm, by 
means of a flexible gum catheter attached to a syringe; 
or hot water with Phenol as above indicated. 



Hernia. 261 

Ante-partum accidental hemorrhage may be treated 
with Ergot in small doses, and Bell, or Brom (pp. 53 & 26), 
if bearing down pains. Injections of iron and hot water 
as in secondary post-partum hemorrhage if necessary; 
and if the os be fully dilated, rupture of the membrane. 

In unavoidable ante-partum hemorrhage, if the bleed- 
ing is but slight, and occurs rather early before the term, 
aside from the recumbent position, cold compresses to 
abdomen and vulva, Plumbum c. Opio (147). If the 
bleeding persist or grow alarming, recourse must be 
had to the tampon, which will not only stop for the time 
the hemorrhage, but will also serve to dilate the Osp 
when, after twelve hours — longer it should not remain — 
premature labor must be induced. See Placenta previa. 

In Abolition, recumbent position, cool room, cold drinks, 
with enemata of cold water or ice to os, and Ergot, acids, 
etc. If alarming, and in advanced stage of pregnancy. 
the cold douche or hot water injections as in post-partum 
hemorrhage; or the styptic solution of iron as in second- 
ary post-partum hemorrhage. In the earlier stage, a tarn - 
pon, moistened, if possible with a weak solution of Phe- 
nol, which may remain there for 6 to 12 hours; or a piece 
of soft sponge, large enough to fill the vagina without 
inconvenience, and wrung out of pretty sharp vinegar, 
should be carried up to the os, and renewed if necessary. 
During or after abortion, rest for at least a week is neces- 
sary; as retained fragments of placenta may again and 
again occasion hemorrhage. 

Hepatic Diseases. See Liver. 

Hernia — A protrusion of any viscus from its natural 
cavity, the formed tumor being hmooth, rounded and 
elastic, if the hernial sac contains only intestines, (entero- 



26*2 Hernia. 

cele); but flat, flabby and inelastic, if it contains only 
omentum (epiplocele), the latter requiring however more 
continued pressure for its disappearance. In most cases 
the sac contains both intestines and omentum. Hernia 
maybe reducible or returnable into the abdomen; it may 
be irreducible, i. e. not returnable into the abdomen, yet 
without constriction; and it may be strangulated, that 
is, subject to constriction, which not only prevents its 
reposition, but also interferes with the passage of its 
contents. Reducible hernia presents a soft, compressi- 
ble swelling, which increases in size, when the patient 
is standing, and diminishes or disappears when in the 
recumbent position; and if grasped, it is found to dilate 
on coughing. In irreducible hernia there are dragging 
pains in the abdomen, or perhaps attacks of vomiting, 
which comes on after food, or when patient assumes the 
erect posture, because the protruded omentum or intes- 
tines being fixed, resist the distention or upward move- 
ment of the stomach. (As the patient may not be aware 
of having a rupture, he should in cases of vomiting and 
constipation, especially if the face looks anxious and 
pinched, be examined for it ; first the ordinary seats of 
hernia, such as the inguinal and femoral rings, and the 
umbilicus; then the extraordinary, such as the linea alba 
and the ischiatic foramina, etc., etc.). The symptoms 
of strangulated hernia are those of obstruction of the 
bowels — flatulency and coliky pains, succeeded by vom- 
iting, first of the contents of the stomach, then of mucus 
and bile, and lastly of feculent matter — which, unless 
promptly relieved, will be followed very soon by those 
of inflammation — more or less tenderness, pain and 
swelling locally, with a small, hard and wiry pulse, etc. 



Hernia. 263 

The treatment consists in returning as much of the rup- 
ture as may be reducible by taxis, and if necessary to 
divide any constricting part. As 1^8 hours of complete 
obstruction by strangulation usually results in mortifica- 
tion of the bowels, the operation for dividing the stricture 
should be performed at once, if taxis, aided by Chloro- 
form or Opium (pp. 35 & 119) does not prove successful. 
The most effective way of reducing rupture at the lower 
part of the abdomen is taxis with inversion, which may 
be done, by raising the pelvis on a chair, placed under 
the lower part of the mattress of the bed, so that the 
patient's head and shoulders rest upon the bed itself; 
care being taken that the legs are bent up to the body and 
the trunk itself be bent forward, so as to relax completely 
the aponeurotic structures in the groin. In ordinary cases 
or if there be no strangulation, simple taxis generally 
will suffice: x\fter having emptied the. bladder, the pa- 
tient should he down in an attitude of complete repose, 
if Chloroform is to be used; or he may be made to lie 
in a warm bath , with his thighs raised towards the belly, 
close to each other, so that every muscle and ligament 
connected with the abdomen may be relaxed. Now 
the surgeon grasps the fundus of the tumor, gently com- 
presses it, so as to squeeze out a little flatus and venous 
blood, and with the fingers of the other hand gently 
kneads the parts at the neck of the tumor, occasionally 
drawing them a little downwards, in order, if possible, 
to dislodge them; whilst.the patient, during this opera- 
tion, which may be continued for half an hour, if the 
tumor is not painful, endeavors to 'keep his breath, making 
only from time to time a deep inspiration. Sometimes 
pressure on the abdomen a little above the ring, so ow to 



i 



2G4 Heryiia. 

press back the intestines from the ring, will materially 
facilitate the reduction. Scrotal hernia, even if stran- 
gulated, may often be reduced by boring the* index fin- 
ger of the right hand into the inguinal canal in the di- 
rection of the horizontal ramus of the pubes, whilst the 
tumor is compressed and bent slightly towards the ab- 
dominal wall. In strangulated hernia lical etherization 
has been strongly recommended, where simple taxis 
fails: A tablespoonful of Ether is repeatedly poured 
over tumor and inguinal ring (having previously guarded 
the mucous surfaces, as anus, labia, etc., with some 
grease) so as to produce contraction, when in less than 
■half an hour, reduction may be accomplished with ease. 
In acute strangulation, especially if the pain and vomit- 
ing are violent, a large dose of Opium is most useful, if 
for any reason Chloroform cannot be given. Cathartics 
— Colocynthis or Aloes (p. 90), or enemata — gruel with 
some olive oil, though mischievous in sudden acute 
strangulation, are beneficial in the incarcerated variety, 
if the patient is aged, the hernia large and long irreduci- 
ble, and the attack caused by constipation. After re- 
duction a compress with a bandage, and if necessary a 
full opiate; at all events no purgative. Oleum Ricini c. 
Laudano maybe given after 12 — 24 hours. 

Inguinal Hernia — The protrusion is through one or 
both abdominal rings; the direct or internal form push- 
ing before it the conjoined tendon of the internal oblique 
and transversalis muscles, Just behind the external ring, 
the oblique or external (which is the most common) 
taking the same route as the testicle in its passage from 
the abdomen into the scrotum — H. scrotalis. In women 
it passes down one of those canals on the side of the 



Enter ocele. 265 

round ligament into the labium — H. labii pudendi ex- 
terni — since the labia majora are the analoga of the scro- 
tum in the male, and the round ligaments correspond to 
the spermatic cord. If hernia exists already at, or soon 
after birth, it is called congenital, and may then be en- 
cysted. Whilst in man the diagnosis is not difficult, if 
care be taken, not to confound it with hydrocele (which 
however may co-exist — see same), in women where a 
sense of discomfort upon bending the body, or even up- 
on walking may draw the attention of the patient to the 
affected part, unless there be strangulation at the same 
time, a peculiar gaseous or airy sensation to the touch 
may be felt by absence of all signs of inflammation or 
cedema. Treatment — After reduction the hernia must 
be kept up with a truss, care being taken, that the pad 
do not press against the spinous process of the pubes or 
upon the spermatic cord — in women, a truss should be 
adjusted with a perineal strap, so as to keep the com- 
press of the instrument sufficiently low down to effectu- 
ally close the point of exit. If irreducible, it must be 
supported by a bag truss. A radical cure can only be 
effected by an operation. 

Vulvar Euterocele, a variety of pudendal hernia, 
which descending between the vagina and ramus of the 
ischium to form a tumor in one of the labia, may be dis- 
tinguished from an inguinal hernia, which has descend- 
ed into the labium, by the absence of swelling at the ab- 
dominal rings. In carrying the finger along the vagina, 
the tumor can be traced on its internal wall as far back 
as the neck of the uterus, and the other hand applied to 
the external surface of the labium, the protruding mass 
can be felt between the two hands. Treatment — After 



266 Hernia. 

having placed the patient on her back, with her hips ele- 
vated by a cushion, or still better by having raised the 
foot of the bed, the index finger is introduced into the 
vagina, and the tumor pressed with it against the side 
of the vagina, whilst the lower portion of the tumor ir 
the labium is seized with the fingers of the other hand 
and pushed cautiously back and upward, in a direction 
parallel to the vagina. After reduction a cylindrical 
pessary may be introduced with its base upward, to ex- 
ert pressure on that portion of the vagina, where the in- 
testine made its way between its external wall and the 
ramus ischii. To retain the pessary a T shaped bandage 
will be necessary; and occasionally PiL Gambog. co. with 
some ionic (pp. 71 & 91) to keep the bowels in a solu- 
ble state. Here may be mentioned perineal hernia, 
which descends between bladder and rectum, forcing 
its way through the pelvic fascia and levator ani, and 
forming a tumor in the perineum; and the vaginal her- 
nia, a variety of the former, in which the tumor pro- 
jects into, and blocks up the vagina, instead of descend- 
ing to the perineum. These two, with the pudendal 
last mentioned, must be replaced by pressure with the 
fingers, and be kept up by pads made to bear against the 
perineum, or by caoutchouc pessaries worn in the vagina. 
In slight cases of vaginal prolapse and hernise, as vesico- 
vaginal H. (Cystocele), rectovaginal EL (Hectocele), en- 
tero-vaginal H. {Enter ocele), prolapse of the ovary or 
intestine into the triangular fossa between rectum and 
uterus, etc., etc., local astringents, Alum, Zinc or Tannin 
(359) with copious injections of cold water bis die, as- 
sisted by tonics (p. 70) internally, may be of use. Con- 
stipation must be guarded against by enemata and occa- 



Exomphalos. 267 

sionally one ounce of Castor oil. Great relief may be 
effected by abdominal supporters with perineal band, 
and by the use of a proper pessary: The double lever 
of Hodge or Smith; Meig's ring; the stem of Cutter, or 
the globe pessary of glass or silver, or the air pessary 
of Gariel. The latter two will be of special benefit if 
the bladder or rectum participates in the prolapse. A 
piece of soft sponge, wrapped in oiled silk, carefully in- 
troduced into the vagina, and kept in place by a bandage 
will answer sometimes; but whether sponge or pessary, 
it must be daily withdrawn for the purpose of ablution. 
The curative treatment consists in the removal of the 
relaxed portion of the mucous membrane of the vagina 
by perineorrhaphy. 

Hernia cruralis— Femoral hernia escapes close be- 
hind and below Poupart's ligament, passing first through 
the crural ring, and attains rarely a large size. It is to 
be distinguished from the inguinal by observing that 
Poupart's ligament can be traced over the neck of the 
sack, and that the spinous process of the pubes lies 
internal to and above it. whereas it is the reverse in the 
inguinal hernia. If reducible it should be supported by 
a truss, the pad of which would tell against the hollow, 
which is just inferior and external to the spinous pro- 
cess of the pubes; if irreducible and omental, a common 
pad may be borne, else the pad must be hollow. 

Hernia, umbilicalis — Exomphcdos is most frequent in 
children, soon after birth, and in women who have been 
frequently pregnant. For children, a ten-cent piece, cov- 
ered with adhesive plaster with the sticking side outer- 
most, is the best pad. An adult should wear an elastic 
belt; if irreducible, a large hollow pad. 



268 Hydrocele. 

Ventral Hernia, which protrudes either through th%5 
linea alba or the linem serni-lunares, requires uniform 
support by a properly adjusted bandage. The separa- 
tion of the two recti (abdomino-rectal H.) is frequently 
a result of gestation. 

Herpes. See Skin and Head. 

Hiccough. See Singultus. 

Hives (Urticaria). See Skin. 

Hoarseness. See Laryngitis. 

Hodgkin's Disease. See Leucocythaemia. 

Hooping Cough. See Pertussis. 

Hydatids. See Echinococci; II in utero — Uterus 
(Degeneration of Chorion). 

Hydrocele — A pear-shaped tumor, formed by the 
collection of serum in the tunica vaginalis or spermatic 
cord, commencing in the lower part of the scrotum, and 
growing upwards. It is sometimes a sequel of syphilis 
or of inflammation of the testis; but generally it is the 
consequence of straining of the loins and belly. It is 
painless, causing only an uneasy sensation by its weight, 
and may be distinguished from hernia by being translu- 
cent and fluctuating ; by surrounding the testicle in such 
a way, that the latter cannot he clearly felt— on\y the 
cord can be felt lying above it — ; and by not dilating on 
coughing. In the congenital form a cylindrical tumor 
extends up to or through the deep abdominal rings, 
so that if raised and compressed the fluid is slowly 
squeezed into the abdomen. 

Encysted Hernia is extraperitoneal, whilst in the com- 
mon or congenital form the effusion is poured down 
from the peritoneum, and is usually situated between 
the epididymis and tunica; seldom between the latter 



Hydro-Peritoneum. 269 

and the testis or in some part of the spermatic cord. 
In women the fluid collects in the inguinal canal, around 
the round ligaments, which passing downwards, enter 
the labia majora, and distribute their filaments within 
the dartoid sacs, which extend like glove fingers down- 
wards towards the four chette. The gradual and painless 
development of the tumor, with a sense of flue uation 
without inflammation; and a resonance upon percussion 
make the diagnosis easy. Treatment — Evacuation of 
the fluid (in women by means of an aspirator) followed, 
if necessary, by an injection of Iodine (332). Punctures 
with a needle, though for children sufficient, are for 
adults only palliative. The radical cure with Tod is not 
admissible, if the tunica communicates freely with the 
abdomen, or if there is hernia, or some disease of the part. 

Hydrocephaloid — An infantile affection, dependent 
on exhaustion from diarrhoea and similar diseases, of 
which it forms in fact the closing stage. It is charac- 
terized by re^tlessnes with more or less fever, soon fol- 
lowed by drowsiness, stupor and convulsions, and ter- 
minating generally in death. Treatment — Brandy with 
Opium (pp. 3*7 & 72), in conjunction with due attention 
to the causative disease. 

Hydrocephalus — Unless congenital, an affection of 
early childhood, consisting of an excessive accumulation 
of serous fluid into the ventricles of the brain, giving 
rise to an enormous enlargement of the cranium. Treat- 
ment — Aside from a light diet, aperients (p. 88). For 
Hydrocephalus acutus see Meningitis (tuberculous). 

Hydronephrosis. See Kidney. 

Hydro-Peritoneum — Ascites may be local, or part of 
general dropsy. As local affection it is dependent on 



2 7 Hypoch ondriasis. 

obstruction in the main trunk of the portal vein or its 
branches within the liver, unless it be the result of dis- 
ease of the peritoneum, in which case however the af- 
fection is inflammatory. Treatment as indicated in 
dropsy. Whenever the effusion has been distending 
the abdomen to such an extent as to cause much incon- 
venience, tapping is the remedy par excellence (413), as 
aside from being a perfectly harmless operation, it* is 
sure to give instantaneous relief. 

Hydrophobia — Rabies is a disease caused by inocu- 
lation with the saliva of a rabid animal, and character- 
ized by intermittent laryngeal spasms and an increased 
flow of saliva. Treatment — In many cases Curare (65 
& 259) has been of benefit. Xanthium, Ammonium and 
Cocaine (86, 94 & 168) are also recommended, 

Hydrotkorax — A dropsical effusion into the pleural 
cavities, sometimes due to affections of the pleura, but 
mostly to cardiac lesions, producing obstruction of the 
mitral orifice after having led to dilatation of the right 
cavities of the heart. Treatment — Digitalis or Elaterium 
(108 & 205); or aspiration. 

Hyperesthesia. Mental, and Mental and Physic- 
al. See Hypochondriasis, resp. Hysteria. 

Hyperesthesia or Vulva. See Vulva. 

Hyperplasia. Areolar of Uterus. See Uterus. 

Hypertrophy of Cervix. See Uterus (Hyperplasia); 
of Nymphje — Vulva; of Heart — Heart. 

Hypochondriasis (Hypercesthesia psychica) is some- 
times classed as a neurosis, sometimes as a psychosis, 
the characteristic feature of which consists in a morbid 
attention, which the patient devotes to the study of his 
own physical condition and the unwarrantable degree of 



Hysteria. *^7l 

anxiety which he exhibits regarding it. Sexual Hypo- 
chondriasis and Syphiliphobia — where he believes him- 
self impotent, resp. a victim to syphilis — may be men- 
tioned as forms of the disease. The intelligence may 
become greatly enfeebled and in many cases the separa- 
tion between pathophobia and insanity cannot be distinct- 
ly made. The form of mental aberration resulting most 
commonly, is of the melancholic type, and evidenced by 
delusions connected with the patient's symptoms (he 
may fancy the presence of some animal in his stomach, 
or he may suppose himself persecuted, etc). Next to 
heredity, excesses of all sorts, and depressing sur- 
roundings, overwork in conjunction with chronic abdom- 
inal disease, syphilis or some disorder of the sexual or- 
gans may have a part in it, though frequently the causes, 
mental and physical are alike obscure. Treatment — 
Change of air, combined with judicious management of 
a moral nature will be of benefit. Regular habits must 
be insisted upon, and constipation, piles, etc., should be 
attended to. In case of dyspepsia or anaemia, Nux Vomica 
resp. Ferrum (pp. 71 & 79-81). Arsenic, Brom or Co- 
caine (pp. 9, 24 & 77) may be tried; or Morphine and 
Valeriana (80 & 82), See Insanity. 

Hysteralgia. See Neuralgia. 

Hysteria — An abnormal condition of the mind and 
nervous system, dependent on a variety of affections, all 
of which are connected more or less with the organs of 
generation. While convulsions, coma and delirium of 
a peculiar kind, occurring in paroxysms, constitute the 
severe grades of hysteria (for their treatment see those 
affections), the milder forms are characterized by fre- 
quent neuralgic pains and headache — clavus hystericus 



21 2 Icterus. 

is supposed to be pathognomic-; hyperesthesia and an- 
aesthesia — the former sometimes simulating articular 
rheumatism, sometimes giving rise to a sensation as if a 
round body was sticking in the throat: the not less patho- 
gnomic globus hystericus- — ; cough; retention or incon- 
tinence of urine, etc. The relation between hysteria 
and insanity is about the same as that of hypochondria- 
sis to the latter, but the insane manifestations of hysteria 
involve mainly the maniacal element, the melancholic 
type is less frequent, and a condition of dementia, the 
terminal state of mania and melancholia will be met 
with but rarely. (See Mania). Treatment — Removal 
of cause if possible. Anaemia requires acids ( 1 54) ; Fer- 
rum c. Chinino (pp. 76 & 79); or artificial suppression of 
menses — see Chlorosis—; uterine irritation, Cannabis, 
Chloroform (57 & 61) with Iodoform or Belladonna local- 
ly (356, 374 & 75); perhaps Cocaine (p. 77), etc. In meteor- 
ismus, Aloes and Colocynthis (199 & 203); or Ferrum c. 
Strychn. (pp. 79-82); if neuralgia, Aconite or Camphora 
internally and externally (35, 56, 409 & 410); or Zinc, 
(196); globus hystericus, Cyan, Ammonium (68, 159); or 
Cypripedium (p. 32). In palpitation, Aconite, if action 
strong — Digitalis (171), if feeble and irregular. Of oth- 
er remedies may be mentioned Pulsatilla, Ether, Brom 
(23, 36, 47); Castoreum and Helonias (58 & 179); Arsen., 
Lithium and Lactucarium (pp. 9, 27 & 34). In many cases 
Valeriana and Asa foetida (41) are very effective — 
Opiates are of not much use. 

Icterus {Jaundice) — A yellowness of skin and the con- 
junctiva, produced sometimes by changes in the blood 
itself (hematogenous)'^ but generally by absorption of 
bile by the blood (hejiatogenous), and arising among 



Impotent. 213 

other causes from low blood pressure in the portal sys- 
tem, on obstruction to the passage of bile into the in- 
testine; and occurring chiefly in duodenal catarrh, cer- 
tain hepatic affections, and in connection with several 
general diseases. (The yellow tint of the surface seen 
in some cases of cancer, intermittent fever and chloro- 
sis is readily discriminated from slight jaundice by the 
dbsence of yellowness of the conjunctiva). As icterus 
may persist still for several months after the disappear- 
ance of bile-pigment in the urine, the latter alone is the 
criterion of a successful cure. In cases, where jaun- 
dice is the consequence of some serious affection of the 
liver, and more especially of scirrhus in that region, it 
w T ill prove fatal, death usually ensuing from coma, the 
result of the action of the biliary poison on the cerebral 
mass; — if death be preceded by convulsions, the poison 
acts on the medulla spinalis and its continuation in the en~ 
cephalan. See Liver (Hepatitis parenchymatosa). Treat- 
ment according to cause: Acid, nitro-mur., Ammonium 
Soda, Hydrastis (153, 158, 120 & 180), with laxatives for 
the relief of constipation, Sodii Phosphas (p. 97); etc.; 
or cholagogues — Calomel, PodophilL (pp. 92 & 93) to re- 
store the biliary secretion to its legitimate channel. 
This may be followed by Mercury in alterative doses 
(13); or Belladonna, Hyoscyamus, Conium (pp. 23, 31 &33), 
especially the latter in conjunction w r ith vegetable diu- 
retics (p. 40) and warm baths to eliminate the bile. If 
malarial, Arsenic or Quinine (pp. 9 & 11); if due to ob- 
struction by gallstone; duodenitis, etc.; these affections 
must be treated. In Icterus Neonatorum, Soda (p. 96). 

Impetigo. See Skin. 

Impotenz — Inability to perform the act of coition, 



274 Inanition. 

may, aside from malformation and from lesion of ner- 
vous centers, produced by blows on the head or spine — 
where impotenz is usually permanent — be due to gener- 
al debility; mental perturbation, as timidity; or wasting 
diseases, as diabetes, renal affections and dyspepsia — 
here frequently combined with loss of sexual desire. 
Involuntary seminal emissions, that is, the ejaculation 
of semen and venereal orgasm without any voluntary ef- 
fort, either natural or unnatural, from morbid erethism; 
and spermatorrhoea (a discharge of semen without the 
occurrence of the orgasm), both of which are brought 
on by premature and excessive venery or self-pollution 
— masturbation, onanism — are sure to lead to impotenz. 
Treatment — Strychnine (pp. 71 & 83); Chinin. c. Ferro, 
Mangan (pp. 82 & 85); if morbid erethism, C amphora, 
Cannabis (pp. 27 & 28), ovSalicin (p. 17); if loss of sex- 
ual desire, Aurum, Barium, Lycopodium (3, 5, 76); or 
Phosphor (189 & 194). In spermatorrhoea, alkalies, Co- 
caine (pp. 54 & 77); Ferr. c. Phosph., Cantharis (143, 54 
& 64); or Camphora. In nocturnal emissions, besides 
Camph., Bell., or Zinc (pp. 24 & 8 7); Apis, or Ergot (95 & 
172); &nd icebag or stimulants (411) to spine or perineum. 
Inanition — Starvation is a pathological condition of 
all diseases, which interfere with alimentation and the 
immediate cause of death in many cases of disease 
which prove fatal by asthenia. The diet is, in any case 
of sickness, a most important factor in a successful treat- 
ment, as a judicious alimentation will do much toward 
shortening the disease. Sometimes rectal alimentation 
will have to be resorted to. About 24 years ago, dur- 
ing a voyage of nearly two months, I kept alive with 
chicken-broth, administered mostly jjer rectum a woman 



Insanity, -75 

in her sixth month of pregnancy, who, on account of 
seasickness, which lasted the whole time, from the day 
she embarked in Sydney to the day we landed in San 
Francisco. The irritability of her stomach was such, 
that, with the exception of water given by mouthfuls, 
it rejected everything, and the distressing efforts to 
vomit, which in her state were particularly dangerous, 
could be controlled only by absolute rest and the continu- 
ed exhibition of hydrocyanic acid and other sedatives. 
After a week on terra firma she felt as strong as ever. 

Incontinence of Urine. See Bladder (Paralysis). 

Induration of Cervix and Infarctus Uteri. See 
Uterus (Hyperplasia). 

Influexza — Epidemic Lroncldtis {La Grippe of the 
French) is an essential fever, associated with the bron- 
chial affection, commencing generally with lassitude, fron- 
tal headache and coryza, followed by chills, pyrexia, 
etc., and depending on some atmospheric influence. The 
treatment is symptomatic, embracing aperients (p.- 88) 
and diaphoretics (p. 40) with Opium (78 & 113), and if 
necessary tonics (p. 69). 

Insanity is the general term of the many varieties of 
unsound mind, man is subject to, and which from two 
distinct points of view — first as regards their physical 
origin, and second with respect to their mental form — 
are arranged in a somato-etiological and a psycho sympfo- 
matological group. In the former, the source of the di- 
visions is found in general organic arrest of growth 
(> . g. idiocy)', in perversions and defects of development 
(pjrimary monomania); in general neuropathic states, 
that may assume the shape of major neuroses (epilej}- 
tie — ); or of mental disorder at the time of the physio- 



2 76 Insanity, 

logical crises {senile insanity) ; in general cachexias, toxic 
[morphinism)', and systemic morbid conditions (mala- 
rious insanity)) and in distinct pathological lesions of 
the higher nervous centres (general paresis, syphilitic 
and sympathetic insanity, etc). In thepsycho-sympto- 
matological group the divisions correspond with the 
psychical features and outward manifestations of the 
disease, as depression (melancholia) said exaltation (ma- 
nia) in the sphere of feeling; weakness and stupor {pri- 
mary ?nental enfeeblement and acute primary dementia) 
in the sphere of intellect; and states marked by impair- 
ed volition (abulic insanity) , and of suspended will (som- 
nambulistic insanity) in the domain of will. 

The relative curability of the various types can only 
be stated approximately. Mania and melancholia (see 
these) are the most curable, while general paresis, termi- 
nal dementia, and that class of hereditary cases in which 
all the psychical and somatic symptoms of degeneracy 
are present,may be put down as utterly hopeless; though 
of hereditary cases in general, it may be said, that their 
chances for recovery from a first attack are as good as 
in the non-hereditary types — only that relapses have to 
be looked for. The prognosis is as bad in mental alien- 
ation- originating in trauma capitis and insolation, or 
that, resulting from the gradual transformation of the 
major neuroses (hypochondriacal and hysterical insanity , 
etc.); or from prolonged moral causes, such as anxiety 
and business worry — mental disorder occasioned by sud- 
den violent emotions is often amenable to cure. Insan- 
ity in connection with the scrophulous and tubercular dia- 
thesis does not often admit of a cure; and if produced 
by alcoholic excesses and venery, it is scarcely more 



Fnsolatio. '2 77 

favorable, even before organic changes in the nervous 
centres have taken place. 

The therapeutic principles of psychiatry are not dif- 
ferent from those of general medicine, and since insan- 
ity, in its widest relation, is a disorder, not only of the 
whole nervous system, but of the whole organism, the 
alienist will have to treat each case according to its etio- 
logy. Next to due attention to the relief of urgent 
symptoms, such as obstinate constipation, prolonged in- 
somnia, cardiac failure, precordial panic, inanition and 
exhaustion, is the moral management under medical 
supervision of the highest importance. Regular habits 
as to meals, sleep and exercise, must be insisted upon. 
Sometimes separation is one of the most effective means; 
if necessary, asylum care. Derangement of intellect, if 
threatening maybe treated with electricity (p. 148) or 
Cocaine (p. 109), preceded by Aloes (198). Arsenic (p. 10), 
especially Zinc (195) are sometimes of great benefit. 
The cold douche and Tiglium in maniacal delirium. 

Insolatio — Sunstroke is a congestive apoplexy, pro- 
duced by exposure to great heat or the direct rays of 
the sun, and associated with more or less exhaustion; 
occasionally the latter without the former — here the vital 
powers are protracted, the forces carrying on circulation 
give way, and death takes place by syncope. Hence in 
some cases, the attack is characterized by a strong and 
quick pulse, hot and dry skin, contracted pupils, even 
cramps, in fact all the signs of apoplexy — loss of con- 
sciousness; followed frequently by stertor and convul- 
sions, with not seldom, a fatal termination; in others 
the skin will be pale, the pulse weak and pupils dilated; 
vertigo, headache and listlessness being the chief symp 



278 Insomnia. 

toms. Treatment — The apoplectic form requires the 
wet sheet or sponging (420) and enemata (385); and 
Brom (p. 24) perhaps internally, whilst in simple faint- 
ing stimulants are indicated — Brandy (p. 73); Opium (p. 
73); Ammonium, Digitalis (158 & 250), etc. 

Insomnia — In inability to sleep sedatives are the prin- 
cipal remedies — Opium, Hyoscyamus (71, 79, 195); or 
Brom and Chloral (48 & 60); if stomach irritable, Hy- 
drastis (180). In old people Digitalis (p. 79) is sometimes 
of value. In sleeplessness of typhoid Antimony (p. 23). 
Intermittens. See Fever (intermittent). 
Intertrigo. See Skin. 
Intestinal Catarrh. See Enteritis. 
Intussusception — Invagination is an accidental inser- 
tion or protrusion of an upper into a lower segment of 
intestine, occurring mostly in infancy, and causing 
bloody stools with tenesmus and perhaps vomiting. 
Treatment— Enemata to irrigate the bowels and Opium 
p. os (p. 37). A solution of Sod. Bicarb, followed direct- 
ly by one of Acid. tart, may be tried. See Rectal diseases. 
Inversion of Urethra and Uterus. See Urethra, 
resp. Uterus. 

Iritis. See Eye. 
Irritation. Spinal, See Spine. 
Irchias. See Neuralgia (cruralis). 
Ischuria renalis is only of diagnostic value in reten 
tion of urine (by the catheter), since the kidneys having 
ceased to secrete it on account of disease, its suppres- 
sion is invariably fatal. For Ischuria paralytica see 
Bladder (Suppression of urine). 
Itch. See Skin (Scabies). 
Jaundice. See Icterus. 



Joints, 279 

Joints — Synovitis or Inflammation of the synovial 
membrane, produced, aside from injury and other local 
causes, by the rheumatic, gouty, syphilitic and gonor- 
rhoeal poison, the exciting cause being frequently expos- 
ure to cold, is characterized by a rapid effusion of fluid 
into the synovial cavity, accompanied by severe pain, 
great swelling and violent fever. (A chronic form, af- 
fecting the knee — Tumor albus genu — is called by Ger- 
mans Gelenkschwamm). Treatment — After having fas- 
tened a wooden splint, properly padded, at some distance 
above and below the affected joint, to render it motion- 
less, leeches should be applied to the joint, or cups near 
it, with hot fomentations and evaporating lotions (337). 
Internally Calomel (p. 92), or some other brisk aperient; 
and at night Opium (p. 35) to insure rest. In chronic 
cases, & piece of pasteboard, which admits of easily be- 
ing adapted to the surface of the joint, when softened 
in warm water, will be more convenient — moreover a 
swing, if the knee or anclejoint, should be affected, will 
greatly add to the comfort of the patient. At the same 
time an appropriate constitutional treatment: If a red 
sediment in the urine present, alkalies (p. 54) with Colch- 
icum; Iodine (pp. 14 & 48), etc. In the chronic form, 
blisters and other stimulating liniments (402, 408 & 9) 
may be used irrespective of the general treatment. If in 
either form, symptoms denoting suppuration — rigors, 
quick pulse, etc. — should appear, aspiration will be nec- 
essary. In the case of tumor albus, no pressure must be 
made over the patella, therefore instead of the wooden 
splint,a long but light splint of leather should be mould- 
ed on each side of the limb, after having been steeped 
in hot water. 



280 Kidneys. 

Keratitis. See Eye. 

Kidneys — Acute congestion, unless produced by vaso- 
motor influences, incident to diabetes insipidus, certain 
diseases of the brain and emotional or hysterical dis- 
turbances — when the urine is abundant and not albumin- 
ous—is inflammatory, and due to irritation, as the abuse 
of cantharides, nitre, copaiva, etc., and characterized by 
albuminous or bloody urine, which is diminished in 
quantity, and may be even suppressed. If passive it is 
symptomatic of certain pulmonary and cardiac diseases, 
without, however, causing tcrcemia; though the dim- 
inished secretion of urine, which is dark, albuminous 
and bloody, containing a few hyaline casts, and after 
some time throwing down an abundant sediment of 
urates, is sure to increase the general dropsy, which 
usually co-exists. Treatment of the active form, if in- 
flammatory: Camphora (p. 28), with Opium (411) locally. 
In venous congestion, barring the appropriate treat- 
ment of the causative affection, Benzoin (p. 46) is fre- 
quently used; Digitalis (p. 78), to strengthen the force 
of the heart, thereby increasing arterial tension and 
relieving the venous stasis. For Renal Colic and Hoe- 
maturia see Calculi resp. Hemorrhage from the kidneys. 

Diffuse Nephritis — Acute Bright's disease is the col- 
lective name of the various inflammations of all or part 
of the constituents of the kidneys — the interstitial 
tissue, the uriniferous tubes, and the blood vessels — 
thus comprising the various forms, known as catarrhal 
croupous, parenchymatous, desquamative and tubal 
nephritis, accompanied by dropsical symptoms — the 
separation of serum from the blood and its presence in 
the urine, connective tissue and cavities of the body — , 



Bright' s Disease. 281 

commencing nearly always with oedema round the eyes, 
or in the lower extremities and the characteristic urine, 
which is secreted in congestion: Granular and fatty 
casts indicate a more advanced stage of degeneration 
than generally belongs to acute Bright's disease. As 
primary affection, being due to extensive burns, the 
effects of cold, blows and other injuries, it is secondarily 
frequently incident to general diseases, suppurative pro- 
cesses and toxic agents. The treatment of acute neph- 
ritis from blows on the loins, or the irritation of calculi, 
which is characterized by pains in loins and abdomen, 
fever and vomiting, w T ith tenesmus vesicae and scanty 
high colored urine, requires leeches or dry cupping, with 
warm fomentations, and 01. Ricini or Calomel (p. 92). 
Aconite (35) and Opium (p. 37) if necessary. Painful 
and frequent micturition may be relieved by Coccus (62). 
In the other forms, aside from rest, warmth, a bland 
diet and plenty of water to drink, the treatment em- 
braces saline laxatives (p. 96), in conjunction with dry 
cupping over the loins as revulsives, or counter-irritation 
and fomentations over the region of the kidneys. If 
much dropsy, Elaterium or Pilocarpin (pp. 91 & 51); or 
perhaps Digitalis (108). After scarlatina, Aconite (35). In 
unemic coma and convulsions, hydragogues and sudori- 
fics in alternation (see Coma); while, until elimination 
by these means has been effected, Chloral p. os v. p. 
anum (60 & 365), or inhalations of Chloroform (304) 
may be employed to arrest the convulsions for the time. 
Chronic Bright's Disease, comprising like the acute, 
several diseases, which culminate in structural lesions 
of the kidney, constitutes three distinct forms — the large 
mottled, the small granular, and the waxy kidney. The 



282 Kidneys. 

first is generally developed in connection with syphilis, 
chronic suppuration, phthisis and other wasting diseases, 
whilst the small atrophic kidney is mostly associated 
with cardiac hypertrophy; and with the waxy form there 
co-exists frequently waxy degeneration of the liver or 
spleen. Treatment is essentially the same as that of 
acute nephritis: Elaterium, etc.; though sometimes diu- 
retics will suffice, Digitalis internally and externals y 
(pp. 50 & 143); Broom, Petrosel, Blatta, Juniper (100 
& 322), etc. Sudorifics, however, must be relied upon, 
if hydragogues are not borne and diuretics have no 
effect — laborandi (p. 51). A warm water bath will 
generally produce diaphoresis; if not, the hot-air bath 
(417) may be tried. If the genitals and lower limbs 
are very much distended, superficial punctures with a 
pin will afford relief. To diminish the albumen in the 
urine, Acid, gallicum (p. 61) is the remedy; Aurum and 
Cuprum (pp. 10 & 77) are also used. Opium (p. 36) may 
be given for the relief of headache and neuralgia. 
Diarrhoea, if moderate, should not be interfered with, 
(as the vomiting and purging is here due to a vicarious 
elimination of urea) ; if excessive, Acid. sulf. (pp. 61 & 72) 
to neutralize the ammonia; or Cyan, Bismuth, Creosot (pp. 
31, 46, 64), etc. Skim or buttermilk is said to be curative. 
Interstitial or Suppurative Nephritis — The surgical 
kidney is called Pyelitis, if the mucous membrane of 
the renal pelvis is only inflamed; but, if there are at 
the same time small abscesses, it is known as Pyelo- 
Nephritis. The surgical kidney is, aside from opera- 
tions, mostly due to pyaemia, impaction of a calculus in 
the ureter, or diseases of the bladder, and the like, 
which, on account of causing obstruction, lead to an 



Labor. 283 

accumulation of urine in the pelvis and calices, where 
it decomposes and acts as a local irritant. Treatment — 
Removal of cause — Buchu, Arctostaphylum (pp. 47 &68); 
Benzoin (pp. 4(3 & 51); Cantharis (102), etc. Suppura- 
tive nephritis as a primary disease or produced trau- 
matically, claims an antiphlogistic treatment: Cold 
applications or counter- irritation with rest, etc. If en- 
docardial ulceration and other affections present, which 
furnish the infectious emboli and general symptoms, 
they have to be treated. A renal abscess, if large, 
should be evacuated by aspiration. 

Hydronephrosis is a dilatation of the pelvis and calices 
of the kidney on account of an accumulation of urine in 
consequence of some obstruction in the urinary passages, 
which may be congenital or acquired. In some cases 
the dilatation constitutes a sac filling out most of the ab- 
dominal cavity, containing several gallons of fluid, and 
the dilated ureter may reach the size of a coil of small 
intestine. Treatment — Next to the evacuation of the fluid 
by aspiration, the cause must be removed, if possible. 

Hydatids— A cyst may attain in the kidney the size 
of a tumor, perceptible to palpitation. See Echinococ- 
cus. Treatment — A large cyst will generally be de- 
stroyed by simple aspiration; small ones may be dis- 
lodged by Terebinthina (p. 68) in diuretic doses. 

Labia majoea. See Vulva. 

Labor — Parturition is the expulsion of the contents 
of the gravid uterus, when the foetus has attained 
maturity for extra uterine life — generally at or near 
the tenth catamenial period, counting from the one last 
before conception. Labor is called premature, if deliv- 
ery takes place before the full term, but not before the 



284 Labor. 

seventh month of gestation, it being considered the 
time to correspond with the viability of the foetus. If 
not induced intentionally, premature labor, like abortion, 
is a consequence of disease or due to some accident. In 
cases of confinement, the following points may be worth 
to be borne in mind: "The cord should not be severed be- 
fore pulsation has entirely ceased, unless the child has been 
expelled in an asphyxiated state- See Asphyxia. 

2. Traction on the cord should never be made before 
the afterbirth is really detached from the uterine sur- 
face; for, aside from the many accidents which may 
happen through its sudden separation at the time, it may 
blight the life of the young mother for ever after. An- 
other source of much unhappiness in married life is the 
unnecessary use of the forceps. To justify their em- 
ployment, the following conditions must be present: 1, 
no deformity, either of the pelvis or of the soft parts; 
2, os uteri dilatable; 3, one of the obstetrical extremities 
must present; and 4, inertia of the uterus. 

Irregularities during labor may be often avoided, or 
at least more or less rectified: If there be rigidity of 
os. Chloral (p. 30); Antimony (p. 100); inhalations of 
Chloroform (304 & 16); or injections of warm water. In 
feeble contractions, Ergot, though contra-indicated in 
obstetriccd doses, may be given by drops — four of the 
fluid extract every 15 min. ex aqua; or Cimcifuga (p. 49); 
if they are feeble from too great an amount of Liquor 
Amnii — known by the large size and extreme tightness 
of the abdomen — the membrane should be ruptured, pro- 
vided the os be dilatable. For procuring sleep in pro- 
tracted labor, or in afterpains, Opium (11 & 79); Chloral 
or Gelsemium (p. 32). To prevent septicaemia, Occlusion 



Larynx. 285 

pad (371); Aconite c. Salicin. (p. 22). For flooding, see 
Hemorrhage in Labor. 

Premature Labor is conducted on the same principles. 
The induction is indicated in deformity of pelvis, ob- 
struction from large tumors, certain cases of placenta 
previa, diseases, etc. After having dilated the os by the 
introduction of a tent, made in suitable form of slippery 
elm bark, an oiled bougie is pushed merely so far as to 
r the os, and then a tickling motion performed. If 
by this titillation the uterus should not begin to con- 
tract, the instrument may be introduced again after 
about 12 hours, and pushed a few inches between the 
uterus and the membrane, without, however, rupturing 
the latter, and left there for a few hours until the pains 
come on. Before rupturing the membrane a binder 
may be applied to the abdomen and gradually tighten- 
ed, so as to keep the head in close apposition to the os, 
which will prevent the cord from being washed down 
i»v the rush of the water. For the prevention of pre- 
mature labor, see Abortion. 

LachPwVmal Apparatus. See Eye. 

Larynx — Fhreign Bodies in the larynx and trachea. 
If the symptoms urgent and surgical assistance in time, 
the patient should be putunler Chloroform (394 & 16), 
as to relax the muscles, which guard the aperture of the 
glottis, and then be turned upside down — a child may be 
held with its head downwards and slapped on the back 
without ceremony. In less urgent cases Opium, Chloral 
or Hyoscyamus (pp. 20, 33 & 3 7), the patient being con- 
fined to the bed, when the substance may become coated 
with mucous and be expectorated during coughing or 
vomiting. If however by these means removal cannot be 



286 Larynx. 

effected, laryngo — or tracheotomy (295) will be required. 

Laryngismus stridulus. See Spasmus Glottid is (p. 288). 

Laryngitis acuta — Catarrhal Laryngitis is generally- 
preceded by the subacute inflammation or a common 
cold, accompanied by more or less spasm of the glottis, 
and characterized by a husky stridulous cough (in child- 
ren, false croup — see Spasm (p. 288), loss of voice and 
fever. As a primary affection it is mostly due to expo- 
sure to cold. Treatment — Hot fomentations; co/d com- 
presses, or Acid. acet. (294 & 98) to throat; and Opium 
or Belladonna (43, 78 & 79) to allay spasm and cough, 
will as a rule, be sufficient. Sometimes, however, the 
disease is much more severe in adults than in children; 
therefore tracheotomy (295) should be performed as 
soon as the obstruction in the larynx occasions retrac- 
tion of the lower part of the chest in inspiration and be- 
'fore the occurrence of lividity. 

The subacute form, which is but mild, characterizing 
certain cases of a common cold, hoarseness or aphonia, in 
connection with a cough and a viscid expectoration being 
the most prominent symptoms, claims a similar treatment, 

Chronic Laryngitis on the other hand is a constant 
companion of more or less ulceration of the larynx, 
which, if not the result of syphilis, is mostly due to pul- 
monary phthisis. In addition to the usual symptoms of 
acute or subacute laryngitis, it is characterized by dif- 
ficult deglutition, occasionally spasms of the glottis with 
dyspnoea. The treatment relates to the causal disease 
and complications. To alleviate the cough, Opium, Bell,, 
Hyoscyam. (23,43, 78 or 113 &l2!2); or Cyan (68 &307), 
Pimpinella (116) is sometimes very effective in aphonia 
or hoarseness, but above all inhalations of Acid, nitric. 



(Edema Glottidis. 28Y 

Phenol,Tannin and Ammon. Chlor. (298-309 & 323), with 
occasional applications of Argentum ox Iodine (288 & 293). 

Laryngitis exudativa — Membranous or true croup is 
a local disease, characterized by fibrinous exudation in 
the form of a false membrane in the larynx, trachea, 
and frequently the larger bronchi, involving as a rule 
the pharynx, tonsils and adjacent parts, accompanied by a 
peculiar shrill, barking cough and difficulty of breathing. 
The treatment consists, aside from cold compresses (298) 
to throat at intervals of a few minutes, or Acid. acet. 
(294), in emetics, Ipecacuanha or Turpeth ter v. quater die 
(pp. 100 & 101); or Apomorphine (p. 107) to compensate 
for the want of voluntary expectoration and the lime- 
steam bath (418). Ferrum (1 74) in conjunction with 
inhalations of Brom (313) are recommended. As a last 
resource laryngotomy (295). 

Oedema Glottidis — The serous or sero-purulent effu- 
sion in the submucous tissue above —seldom below — the 
vocal cords, especially in the ary-epiglottic folds about 
the ventricle of Morgagni and the base of the epiglottis, 
constitute tumors, which, as they project on each side, 
impeding more or less the inspiration, may readily be 
felt with the finger. Aside from being caused by injury, 
the swallowing of irritant poison or hot water, oedema 
of the glottis is chiefly due to inflammation of the 
neighboring parts, and occurs frequently in the course 
of general diseases, as typhoid, phthisis, Bright's disease, 
variola, etc. In kidney diseases it is sometimes the first 
and only dropsical symptom. Treatment — Leeches; in- 
halations of steam, medicated or no (303 & 9); applica- 
tions of Arg. nitr. (288), and shallow scarifications, with 
free purgation (p. 92) in acute, whether occurring during 



288 Larynx. 

simple sore throat or in connection with erysipelas, scar- 
latina, etc. If dyspnoea intense and suffocation immi- 
nent, laryngotomy (295). Sometimes pressure with the 
finger or fingernail will suffice to open the tumors. 

Spasmus Glottidis — A morbid susceptibility to spasm 
in the laryngeal muscles, dependent on irritation of the 
vagus, the motor fibres of which are distributed in this 
locality, is, aside from being incidental to various in- 
flammations of the larynx, and sometimes associated 
with hysteria, peculiar to infantile life under two years: 
Laryngismus stridulus, popularly known as^s of hold- 
ing the breath, is a primary affection, and characterized 
by a shrill, whistling respiration, culminating in the 
suspension of breath, until the face becomes congested 
and livid, and often accompanied by carpo-pedal spasms 
or convulsions. Treatment — During the paroxysm, 
cold water dashed in the face, or, what is still better, 
the touching of the glottis with the finger, or the intro- 
duction of a catheter (296). At the same time Brom or 
Hyoscyamus (pp. 25 & 33); or enemata of brandy or 
Phenol (179 & 80); or the wet pack (420). In case of 
constipation, or irritation from teething, Mercury (p. 93); 
if gums swollen and hot, lancing. The presence of 
worms requires Santonine, etc., with proper attention to 
the general health. Spasm of the Glottis, occurring in 
children over two years and accompanied by more or 
less laryngeal irritation, is known as spasmodic or false 
croup (pseudo-cro'icp). It is characterized by a shrill 
sounding cough, with difficulty of breathing, which 
usually quite suddenly interrupts the sleep in the 
middle of the night, and may be easily discriminated 
from true croup by the abruptness of the fit and the 



Leucocythcbmia . 289 

absence of fever ', as well as any buskin ess or hoarseness 
of voice. Treatment — Fomentations or cold compresses 
to throat (208), and, perhaps, a hot foot-bath. If the 
stomach be overloaded, a mild emetic — Ipecac, Alum or 
Cuprum (p. LOO), followed by Aconite or Brom (35 & 49). 

Spasm of the Glottis in adults, which is characterized 
by intermittens of the dyspnoea, requires simple anodynes 
and antispasmodics, Cocaine, etc. (p. 20). 

Lateroflexion. See Uterus (Displacements). 

Lead Colic and Lead Palsy. See Enteralgia resp. 
Paralysis from lead. 

Lentigo. See Skin. 

Lepra — Leprosy, which does not prove fatal by it- 
self, but predisposes, like other incurables, to diarrhoea, 
phthisis or renal disease begins with an eruption of the 
skin, to which is superadded disease of the nerves, char- 
acterized by numbness, distortion and mutilation of the 
extremities; or a crop of tubercles in the face; or 
both. It must not be confounded with psoriasis scutel- 
lata, which is sometimes called lepra vulgaris; nor 
with lepra syphilitica, sax aggravated variety of syphilit- 
ic psoriasis. Treatment — Aside from a nutritious diet 
and cleanliness, Acid, nitro-mur. (153) to improve diges- 
tion; and locally Copaiva. Arsenic (p. 9) is also much used. 

Leptomeningitis. See Meningitis. 

Lei:cocytil/Emia or Leukaemia is a chronic disease, 
characterized by a superabundance of white corpuscles 
in the blood, supposed to be owing to their increased 
formation in the lymphatic glands, spleen and marrow 

of the bones, and attended by swelling of the glands 

those of the neck and axilla being mostly first affected — , 
enlargement of spleen, a hemorrhagic diathesis and 



290 Leucorrhcea. 

general anaemic symptoms. Without an increase of the 
white corpuscles in the blood, but with the same ana- 
tomical changes, as hyperplasia of the glands, enlarge- 
ment of spleen and alterations in the marrow of the 
bones, it constitutes Pseudo-leucocythmmia. known as 
LTodgkin's disease, Lymphatic Anaemia or Malignant 
Lymphoma, Treatment — In addition to good nourish- 
ment, sea bathing, and other hygienic measures, tonics — 
Arson. ,Ferr. 9 Phosph. (pp. 9,79 &87); 01. Jecor.(\o. 84), etc. 
Leucorrhcea is the collective name of a variety, of 
discharges from the female genital apparatus, secreted 
by the different parts of its mucous surface, when in- 
flamed or morbidly irritated. Thus it may be caused 
either by congestion — subinvolution of uterus or vagina; 
suppressed menstruation, fibroids; polyps; or fungous 
vegetations; prolonged lactation; gestation or parturi- 
tion; excessive coition; displacements; or by inflamma- 
tion — endometritis; granular degeneration; syphilitic 
ulceration; vaginitis, etc. The discharges may be 
either mucous, purulent, muco-purulent or watery; and 
the vaginal form, which is acid, consists of abraded 
epithelium and pus; whilst vulvar leucorrhcea has, 
owing to the numerous glands in that part, a more or 
less rancid odor. But there exists no test to distinguish 
gonorrhoea — the discharge due to contagion — from that 
arising idiopathically, and the diagnosis must be chiefly 
a matter of inference. True leucorrhcea, popularly 
called the whites ox female weakness, however, is a tena- 
ceous alkaline mucus, being sometimes transparent 
like raw white of an egg, or having the appearance of 
the white boiled — if greenish, it is mixed with pus — , 
and is secreted from the surface of the cervix uteri. A 



Liver. 291 

discharge of clear viscid mucus from the vagina is not 
infrequent in feeble women, the parts of generation 
being patulous and relaxed. 

Vulvar and vaginal leucorrhoea is common to all 
ages of woman's life; but the uterine form is rare in 
childhood, yet frequently met with in chlorotic girls, 
where it will precede or follow menstruation. The 
leucorrhoea, which accompanies pregnancy, and which is 
>ecreted by the follicles of the lips of the os, is intended 
to prepare the parts for their ultimate distension, and 
..onsequently must not be interfered with; and whites, 
which are observed sometimes at menopause, may here 
act as a wastegate, and should neither be rashly arrested. 
Treatment according to cause (see Vaginitis, Vulvitis, 
Carcinoma, etc.) Excercise, bathing, and a good diet; 
with tonics, Quinine (p. 70), etc. Locally Argentum (343) 
<»nce a week, with copious astringent and soothing vaginal 
injections (358-60), to be used twice a day. In cases 
of chronic vaginitis astringents do sometimes harm when 
Inf. Lini vel Ulmi may be employed; though in chronic 
endometritis astringents will prove beneficial, since 
they tend to harden the mucous lining of the vagina, and 
thus prevent vaginitis. 

Lichen. See Skin. 

Lithiasis. See Urinary deposits. 

Liver — Congestion of the liver (Hypercemia Hepa- 
tis), if acute, is but transient and produced by excessive 
eating and drinking. It is characterized by a sense of 
weight in the right hypochondrium, bitter taste with loss 
of appetite and headache; sometimes nausea and vom- 
iting; and the rapid reduction to the normal size of the 
swelled organ, after removal of the cause, which maybe 



292 Liver. 

effected by saline cathartics (p. 95). In torpor of the 
liver — a functional affection dependent on deficiency of 
bile, Potass, (p. 50), — a morbid excess of bile is supposed 
to enter into the etiology of diarrhoea, colic, etc., whilst 
the greenish color of the stools often observed in in- 
fants, is believed to be due to acrid (vitiated) bile. 
Passive Congestion is always chronic, and produced 
either by uncompensated valvular lesions, or obstruction 
in the pulmonary circulation, as emphysema, chronic 
bronchitis and pleuritis. The increased size of the pe- 
culiarly mottled organ — nutmeg liver — , a slight degree 
of icterus, in which as contradistinction from common 
jaundice, the stools remain bilious, and a more or less 
cyanotic face, followed by ascites and oedema of the ex- 
tremeties, as soon as the liver begins to atrophy are the 
most prominent symptoms. Treatment can be but symp- 
tomatic. Salines. 

Abscess— When the existence of an abscess is conject- 
ured by a fluctuating tumor over the liver, it may be 
explored, eventually evacuated by aspiration, as there is 
no risk of pus escaping into the peritoneal cavity, even 
if there is no adhesion. When the abscess discharges 
through the bronchial tubes or the alimentary canal, 
the treatment will be limited to tonics (p. 69) and appropri- 
ate remedies for the relief of undue irritation. Hyda- 
tids in the liver are characterized by the absence of all 
symptoms, unless the tumor be large enough to cause 
pressure upon the adjacent parts. If the tumor does 
not open externally, nor discharge, by expectoration or 
dejections, it may be aspirated like an abscess. Gall- 
bladder distended by liquid will form a tumor, character- 
ized by jaundice and absence of bile in the stools if the 



Hepatitis -fibrosa. 293 

ductus communis choledochus be obstructed; by serous 
or purulent fluid and absence of jaundice, if the ob- 
struction is in the cystic duct. Aspiration. 

Perihepatitis — Inflammation of the covering of the 
liver and Glisson's capsule may be caused primarily by 
trauma; but is mostly secondary to carcinoma or syphi- 
lis; sometimes it may follow inflammation of the peri- 
toneum or the liver itself. It is characterized by severe 
pains in the region of the liver, with vomiting of bile; a 
violent fever, ushered in by chills; and a most painful 
cough with dyspnoea. The absence of swelling of the 
liver, distinguishes it from parenchymatous hepatitis. 
Treatment according to cause. 

Hepatitis fibrosa interstitialis or Cirrhosis of the 
liver is the diffuse form of chronic interstitial inflamma- 
tion, which leads to more or less contraction of the 
organ, accompanied by the various symptoms of passive 
congestions in the portal system — ascites, icterus and 
enlargement of spleen. Ascites is generally the first 
symptom suggesting the existence of the affection, 
which is confirmed by the diminished size of the liver 
(the previous gradual enlargement, though attended 
with more or less tenderness, being neither taken notice 
of), the high colored urine from the abundance of blood 
pigment and a large deposit of urates, though albumin- 
uria is usually rare, — in some cases there is profuse hem- 
orrhage without dropsy. It is due principally to the 
abuse of alcohol (hence its popular name of gin or whisky 
liver); sometimes to malaria, syphilis and other causes. 
Cardiac and renal diseases are occasional complications. 
The treatment is symptomatic, see Hydro-peritoneum 
and Hemorrhage. 



294 Liver. 

Hypertrophic Cirrhosis is called the affection, when 
the liver remains large. In this form jaundice is more 
persistent than in ordinary alcoholic cirrhosis, and if it 
is due to syphilis, gummata may be felt sometimes as 
hard nodules on the surface of the liver. Treatment— 
Arsenic (p. 9); Acid, nitro-muriat. (153); Ammonium and 
Soda (120 & 158), etc. See Icterus. Portal Thrombosis 
may be secondary to cirrhosis; but generally it is due 
to pressure from without, impacted gallstones, portal 
phlebitis, etc., and though not standing in any relation 
to spirit drinking, it has the symptoms of cirrhosis; only 
the accumulation of the dropsical effusion is more rapid, 
which claims, however, the same treatment. 

Hepatitis parenchymatosa (Malignant or hemorrhagic 
jaundice) — Acute yellow atrophy is a diffuse parenchy- 
matous inflammation of the liver, which rapidly dim- 
inishes in size (whilst the spleen enlarges), attended by 
hemorrhage and ureemic symptoms — headache and de- 
lirium, soon eventuating in convulsions and coma. Oc- 
curring especially in pregnants and parturients in conse- 
quence of violent emotions, this grave disease is either 
developed abruptly or preceded by a prodromic stage, 
during which the highly acid urine will, when cool, de- 
posit a greenish yellow sediment, showing the presence 
of leucin and tyrosin — supposed to be diagnostic — with 
a diminuition of urea. Treatment — In the prodromic 
stage Quinine in full doses (p. 11), or Calomel, etc. — 
see Icterus. Coma, convulsions and hemorrhage require 
appropriate remedies. Afterward mineral acids (p. 71). 

Hepatitis suppurativa — A circumscribed inflamma- 
tion of the liver leading to suppuration may, aside from 
trauma, or from obstruction by gallstones, be secondary 



Lochials. 295 

to dysentery and similar diseases, when emboli from 
ulcerative processes should find their way into the 
liver, and is characterized by pain and swelling in the 
region of the organ, accompanied by an enlargement of 
the spleen; if matter should form, there will be in 
addition repeated chills. 

JBepar adiposum — Fatty liver, dependent either on 
excessive introduction or production of fat in the organ, 
or ondiminuition of oxydation, is characterized only by 
an increase in size, without induration or any subjective 
symptoms. The enlargement, which in drunkards is 
followed by cirrhosis, may be so great that the liver- 
sound will reach as far as the navel. Generally no treat- 
ment required. See Adipositas. If abuse of alcohol the 
cause: Regulation of diet. In co-existing phthisis Cocf- 
liver oil may be taken without fear. Conium (p. 31). Waxy 
liver is also enlargement without any other symptoms, 
therefore only of diagnostic interest, the treatment being 
directed to the disease, with which it is connected — syph- 
ilitic, scrophulous and tubercular cachexia?. Calomel '(208). 

Lochials are called the physiological product of in- 
volution of the uterus after labor, consisting of a vaginal 
discharge, which the first few days is sanguinous [Lochia 
rubra) ; after about four days serous (X. serosa)] and 
after a week, milky (X. lactea). Suppression of the 
lochials may be due to cold, inflammation of the womb, 
or some febrile excitement, and is generally attended 
by headache and vertigo. Treatment- A linseed poul- 
tice with a tablespoonful of Camphora over the vulva; 
steam of a decoction of Leonurus cardiaca or Ricinus 
communis, (see p. 1 T 7 ) ; or a pediluvium (419); with 
salines (p. 96); or Calomel (p. 92), if much plethora. 



296 Lungs. 

Lockjaw. See Tetanus. 

Locomotor Ataxia. See Ataxia. 

Loss of Memory. See Debility. 

Loss of Voice. See Aphonia. 

Lumbago (Lnmbodynia). See Myalgia. 

Lungs. Hypercemia Pulmonum — Active congestion 
may be due to increased action of the heart, arising 
from inha'ation of irritating vapors, spirit drinking and 
mental emotions; if partial, to emphysema and other 
diseases, which cause the unobstructed flow of blood 
in the not affected parts to be more or less vehement; 
and is characterized by a feeling of oppression, and a 
want of air, or increased frequency of respirations and 
dyspnoea in proportion to the degree and extent of the 
congestion, together with a quick pulse. Sometimes 
there is palpitation and a short cough, followed by a 
scanty expectoration, more or less streaked with blood. 
If the congestion increases so as to eventuate into 
(edema, which consists of a transudation of serum into 
the interlobular tissue, the alveolar walls and air cells, 
and is always dependent on other pathological condi- 
tions, dyspnoea will become extreme, expectoration 
serous and frothy, followed soon by the symptoms of 
poisoning by carbonic acid: small and intermittent 
pulse, the skin covered with a clammy perspiration; 
moist bronchial rales, etc., etc., and death. Whilst in 
simple hypercemia percussion and auscultation give 
negative results, pulmonary oedema will produce dul- 
ness on percussion, associated with the moist bronchial 
rales. Passive Congestion is a consequence of heart 
disease, especially valvular lesions, dilatation and fatty 
degeneration. If occurring in the dependent portions of 



Hoemoptysis, 297 

the lungs, it is called hypostatic congestion , which is in- 
cidental to protracted and debilitating, and acute infec- 
tious diseases, and may also result in a transudation of 
bloody serum, known by dulness of that part of the 
thorax. Treatment — In active congestion: Cardiac seda- 
tives (p. 20); Nitre (p. 56); saline cathartics (p. 95), 
etc.. with revulsives locally — dry cups, sinapism, etc. In 
the passive form, stimulants: Alcohol (p. 73); Digitalis 
(p. 78), etc. In pulmonary oedema, if connected with 
dilatation of the heart, or when accompanied by feeble 
pulse and cyanosis, alcoholic stimulants with revulsives, 
footbath (419), etc. Occurring in kidney disease, the 
treatment is directed to the dropsical affection. If 
adynamia, tonics (p. 69). In oedema occurring so sud- 
denly as to endanger life, venisection. The hypostatic 
form may be prevented by frequent changes of the po- 
sition of the body. 

JTcemoptysis is aside from being the result of an aneu- 
rismal tumor, etc., bursting into a bronchus, due either 
to bronchorrhagia or pneumorrhagia. In the former, it 
is owing to rupture of capillaries and other minute ves- 
sels of the small bronchi, which may be produced by 
violent muscular exertion or great mental excitement; 
or it is a consequence of the increased blood pressure 
in the pulmonic system from not compensated heart dis- 
ease; or collateral congestion in connection with suppress- 
ed menstruation, etc.; or from a morbid susceptibility of 
the vessels to break — a premonitory sign of phthisis. 
The expectoration of the blood which is generally pure, 
frothy, of a bright red color and a sweetish taste, is 
mostly preceded by a sensation of the presence of a warm 
liquid in the chest, with or without oppression, and verti- 



298 I/ungs. 

go, etc. Pneumorrhagia in the circumscribed form ma}" 
be conjectured, when in cardiac disease, connected with 
dilatation of the right cavities — demonstrable by in- 
creased dulness towards the right with increased second 
pulmonic sound — there is a fit of great dyspnoea with 
cough and an expectoration of dark blood with mucus y 
but without fever. Hemorrhagic infarction, with or 
without haemoptysis, is due either to thrombosis or em- 
bolism of branches of the pulmonary artery; and as here 
the blood is in the air-cells and interstitial tissue, without 
laceration of the pulmonary parenchyma, it may, unless 
absorbed or expectorated lead to gangrene, to embolic 
pneumonia, or, if the emboli contain infectious matter 
metastatic abscesses. Diffuse pneumorrhagia or pul- 
monary apoplexy consisting of extravasation of blood 
with destruction of lung-tissue and resulting usually from 
trauma (stab-and gunshot wounds) is easily recogniz- 
ed, the patient lies cold and pale and death will some- 
times take place before the blood appears. For the treat- 
ment of haemoptysis see Hemorrhage (from the lungs). 
Pulmonary Gangrene — A necrosis of lung-tissue, at- 
tended by decomposition, may be either diffused or 
circumscribed and occurs, aside from trauma — penetra- 
ting wounds, etc. — in infectious diseases, and various af- 
fections of the lungs. It is characterized by accelerated 
breathing, pain and cough, followed by sjmta more or 
less discolored, according to the amount of pus and 
blood present, in which, in contra-distinction from fetid 
bronchitis, or decomposition of the contents of the pul. 
monary cavities, may be visible shreds of lung-tissue to 
the naked eye, and of a more penetrating odor than that 
which is peculiar to pulmonary abscess. Treatment — A 



Pneumonia. 209 

nutritious diet with tonics, Quinine (p. 76); Ferrum or 
Potass (pp. 55 & SO); disinfectant inhalations, Phenol, 
Pix, etc. (302, 323 & 24): and to alleviate the cough, 
0/W//77 (p. 37). 

Pneumonia crouposa s. Jibrinosa — Acute lobar pneu- 
monitis or pneumonic fever is an acute inflammation of 
the lung-tissue, running, when idiopathic, a definite 
course, characterized by three distinct stages: Active 
congestion {engorgement)- -solidification {hepatization) 
— and resolution, or, if the inflammatory products in- 
stead of being absorbed, become a cheesy mass, purulent 
infiltration (suppuration), in which latter case it maybe 
followed by chronic catarrhal pneumonitis, cirrhosis, 
gangrene, or abscess. Secondary pulmonic fever is -fre- 
quently complicated with typhoid, dysentery and other 
affections. (In typhoid pneumonitis the typhoid state 
does not involve the essential fever, as in typhoid com- 
plicated with pneumonitis). There are cases in whioh 
lobar pneumonitis if perfectly latent, so that only an 
exploration of the chest will reveal the existence of the 
disease; but generally it produces more or less distinc- 
tive symptoms. The fever, which is preceded by a 
chill, if severe, is usually accompanied by headache, 
delirium, vigilance, etc., etc. Pain and cough, unless 
wanting, may be very harassing. The pain is lancinat- 
ing, as in pleuritis (which disease in the dry or circum- 
scribed form always co-exists — constituting, if effusion 
should take place, pleuropneumonia) ; it will, however, 
diminish in the second stage. The cough in this stage 
is also less troublesome than in the first, the expectora- 
tion becoming more easy: The rusty sputa are patho- 
gnomic, as is the hectic flush on one or both cheeks, jot 



300 Lungs. 

herpes labialis, if present. The respiration, on the other 
hand, will be even more hurried, in consequence of the 
.solidified portion of the lung not participating in the 
respiratory function; but it will improve like the other 
symptoms, when resolution begins — their aggravation 
would indicate suppuration. Whenever lobar pneumon- 
itis is suspected, both sides of the back, below the scapula, 
should be examined at once, since, if the inflammation 
be primary, a lower lobe of the lung is mostly affected 
first: More or less dulness on percussion with fine dry 
{crepitant) rales — Zellenknistern, tohich are limited to the 
inspiration and pathognomic, characterize the first stage. 
In the second stage the dulness is more pronounced, 
and in addition there are moist (subcrepitant) rales — 
Knisterrasseln, the finest kind of moist rales, in sound 
similar to that, produced by passing the hand lightly 
over a new piece of taffeta, and to be heard also during 
expiration — , broncho-vesicular and bronchial or tubular re ■ 
spiration with bronchophony, which indicate solidification. 
In children under 5 years the disease is sometimes 
ushered in by convulsions; or it may be masked by a 
violent fever, associated with cerebral symptoms, or 
those of acute gastro-enteritis; it may even remain 
latent, as it often does in the adult — in which case a 
moaning or grunting sound accompanying the expiratory 
act is of frequent occurrence and diagnostic — ; however 
generally an increased frequency of respiration, which 
^mounts often to 60 p. m., and causes the alee nasi to 
dilate; and the characteristic flush on the cheek are co- 
existing with the high pyrexia and a pulse of from 150 
—200 p. m. As pneumonitis is unilateral, there is, as a 
rule, no difficulty in differentiating it from capillary 



Phthisis. 301 

bronchitis, since that disease is bilateral — saber epitant 
rules consequently to be distinguishable on both sides; 
moreover, bronchial respiration or bronchophony never 
exist in the latter. Treatment — Quinine (7) at the be- 
ginning may arrest the disease; else it is not indicated, 
unless the axillary temp, be above 102 degrees, in which 
case sponging or the wet pack are important auxiliaries 
(420). If the fever not severe, Nitre (122); Aconite; 
Antimony (p. 23); or saline purgatives (p. 96). Warm 
fomentations or cold compresses over the affected part — 
the former as revulsives, the latter as painkiller, by 
diminishing the determination of blood to the part. If 
restlessness, cough, etc., Opium (p. 36); if delirium and 
headache, Brom (p. 27); or vigilance, Digitalis (pp. 50, 
56 & 73). In the second stage, Ammonium (p. 73) as 
stimulant, especially if much dyspnoea, with dry cups or 
Iodine locally. Brandy (p. 72) as support at any time 
if required, especially if weakness with a frequent, 
vibratory or thrilling pulse. As regards the adminis- 
tration of Alcohol and Opium to children, see pp. 35 & 73. 
For Pneumonia catarrhalis sen notha (Lobular Pneu- 
monitis) see Broncho-pneumonia Infantum. 

Phthisis — Tuberculosis or Pulmonary Consumption, 
essentially a chronic catarrhal or interstitial pneumonia, 
superadded to a formation of tubercles, the product of 
a constitutional dyscrasia, and invariably accompanied 
by a dry pleuritis, is, aside from a congenital or heredi- 
tary diathesis, chiefly due to acute pulmonary or bron- 
chial inflammations, and often complicated with tuber- 
culous disease of the intestines, tuberculous laryngitis, 
pleuritis with pneumothorax, etc., etc., even kidney dis- 
ease may co-exist. It is attended in the first stage by 



302 Lungs. 

a slight hacking cough, which, though dry at the be- 
ginning, is soon accompanied by a scanty expectoration 
of frothy mucus, sometimes streaked with blood. 
Haemoptysis generally follows next, and whilst the 
sputa grow more abundant and opaque, feverish symp- 
toms with frequent chills will set in, and a shooting 
pain may be felt occasionally under the scapula. As 
the disease mostly begins at the apex of one lung, there 
will be on that side the characteristic depression of the 
supraclavicular region. Crepitant and subcrepitantrafes, 
the former due to pneumonitis, the latter to bronchitis 
— the secondary, circumscribed form — with pleural fric- 
tion and other crumpling and crackling sounds, each 
and all, if present, will be significant, provided they are 
limited to the summit of the chest, in conjunction with 
dulness on percussion of that part, and if broncho- 
vesicular respiration with exaggerated vocal fremitus 
co-exists. (During percussion the patient should not 
incline his head sideways, since the stretched muscles 
of the neck might produce a dulness). When the dis- 
ease is progressing towards the second stage— -the for- 
mation of cavities — , the cough becomes more trouble- 
some, and the expectoration, generally of a muco-puru- 
lent character, will be in proportion to the number and 
size of the cavities. Diagnostic are the nummular sputa, 
which are round and flat, like a coin, when falling upon 
the bottom of a vessel. Not less significant is the fever, 
which becomes continuous, with evening exacerbations; 
the hectic flush and the burning sensation of the soles and 
palms; the copious nightsweats and the progressive 
emaciation. Colliquative diarrhoea, dependent on tuber- 
culous enteritis, may occur, and sooner or later oedema 



Lupus. 303 

of the feet and ancles — which will disappear again when 
in the recumbent position — mostly due to thrombosis of 
the crural vein. Exclusive the dulness, which amounts 
sometimes to flatness, the bronchial and broncho-vesicu- 
lar respiration — indicative of solidification — and the 
correlative vocal signs, as bronchophony and pectori- 
loqui, there will be heard a tympanitic resonance or one 
of its variations — the cracked and metal — which change 
in /tight, if during percussion patient alternately opens 
and closes his mouth (indicating the existence of a 
cavity), with cavernous and amphoric respiration. Treat- 
ment — Alcoholic and fermented liquors, if they be borne, 
with tonics, Quinine, Ferrum, Strychnine (pp. 75, 80 & 83), 
and an invigorating diet, including "milk cures," in 
conjunction with out-of-door life and daily sponge baths 
(04-68 degrees) are of prime importance. Glycerin ; 01. 
Jeco r is (pp. 81 & 84); Benzoin and Cocaine (pp. 46, 58 
A 77); Arsenic (p. 9); Potass (p. 55). Hypophosphites 
are said to be curative. If cough troublesome, sedatives 
(pp. 23-33); Ammonum (pp. 43 & 44), with soothing in- 
halations (319 & 324); if pain, revulsives or Belladonna 
plaster. Nightsweats require acids (129), Agaricin (131) 
or Airopia (p. 23); diarrhoea, Opium or Bismuth (pp. 36 
<fc46); paroxysms of fever, Quinine, Salicin (pp. 11 & 18), 
or Phosphor (154); and dyspnoea, Ether (304). In pro- 
fuse or offensive expectoration Tar or Creosote (pp. 52 
& 64), in conjunction with inhalations of Phenol or Chlor. 
(302, 317 & 23). For Haemoptysis see Hemorrhage 
from the lungs. 

Lupus non exbdens is a very obstinate form of ulcer 
affecting the face, chiefly of young women of a scrofu- 
lous constitution, which is constantly spreading in one 



304 Lymp ha tics . 

direction, whilst healing in other parts, destroying per- 
haps the aloe nasi or palpebrce. Treatment consists in 
tonics (p. 70), with soothing local applications Mangan, 
Joel or Jodoform (401 & 402) etc. Lupus exedens, a still 
more serious form affecting young people and beginning 
with a shiny swelling of the side of the nose, which 
slowly ulcerates, destroying the nose, roof of the mouth 
and floor of the orbits requires Arsenic (p. 9); and lo- 
cally caustics, Argentum,Chrom (403) or Phenol (398) etc. 

Luxations. See Dislocation. 

Lymphatic Glands — Chronic enlargement of the sub- 
maxillary or cervical glands is chiefly due to scrophulo- 
sis, and is the treatment to be directed to the constitu- 
tional disease: Quinine or 01. Jecoris (p. 15); sulfides and 
tonics (pp. 18 & 70); and locally Iodine or Phenol (20 & 
239). See Bubo. 

Lymphoma. See Leucocythsemia. 

Malacia fa morbid craving for certain kinds of food). 
See Pica. 

Malaria (a special morbific agent of telluric origin, 
causing periodical fever). See Fever (intermittens and 
remittens). 

Mammae. See Breasts. 

Mania — A disorder of the intellect with excitement 
of one or more passions, which, with the exception of 
melancholia, is the most frequent and important variety 
of insanity. The psychical symptoms of mania simplex, 
considered not individually, as in a single case, but col- 
lectively, as occurring in a succession of cases, are: 
Rapidity of thought and exalted feeling with hallucina- 
tions, illusions and corresponding delusions; at the 
hight of the disorder, incoherence of speech, perversion 



Masturbation. 305 

of instincts, with suicidal tendencies, and loss of control 
over actions. The somatic phenomena are insomnia, great 
muscular activity, with absence of normal fatigue, in- 
crease of appetite and sexual intercourse; but general 
loss of weight. Mania puerperalis s. lactea includes 
those cases of mental derangement, incident to preg- 
nancy and its sequela-, the prognosis of which is not un- 
favorable, provided it be caused by simple anaemia or 
functional disorders, which can be removed. The 
derangement is generally preceded by a few prodromal 
symptoms, as insomnia or obstinate taciturnity, and may 
also assume the form of melancholia and dementia, mania 
occurring chiefly during or after delivery; melancholia 
during pregnancy and lactation, and dementia most com- 
monly after delivery and during lactation. Uncom- 
plicated cases of climacteric insanity, are, like puerpe- 
ral mania, amenable to complete recovery, the gravity of 
the prognosis depending on the existence of other dis- 
eases, on the amount of hereditary neuropathic taint and 
of previous mental disorder. Sympathetic insanity is 
also curable, if caused by local irritation for which there 
is a remedy. For Mania apotu, see Alcoholism. Treat* 
ment consists in the judicious exhibition of sedatives 
(pp. 25 & 38); stimulants (pp. 75-79); with cathartics 
(p. 88) and anaesthetics (304 & 16j. Mental alienation 
in consequence of undue lactation, or from excess 
loss of blood during the puerperium, requires a generous 
diet with tonics — Quinine (166); Ferrum (p. 79), accord- 
ing to circumstances. When threatening during preg- 
nancy, Cimicifuga (p. 47). See Insanity. 

Mastodynia. See Breast. 

Masturbation — Onanie or Self -pollution is the un- 



306 Melanwmia. 

natural abuse of the sexual functions, owing sometimes 
to irritation produced by worms, and leading sooner or 
later to seminal emissions and impotence. See the latter. 

Measles — See Morbilli. - 

Meljina — (Hemorrhage from the stomach passed per 
anum). See Hemorrhage. 

Melancemia signifies the presence of pigment in the 
blood— the pigmentation of organs is called melanosis. 
Both conditions are found in s the periodical fevers, and 
depends the degree of pigmentation upon the duration 
and severity of the malarial affection. 

Melancholia — A variety of mental alienation, char- 
acterized by excessive gloom, mistrust and depression, 
with insanity on one particular subject or train of ideas, 
(demonomania, erotomania and nostalgia may be re- 
ferred to this head). The psychical symptoms viewed 
collectively are: Limited range of thought and ideas, 
impaired memory, persistent despondency, and social 
apathy, with loss of will power, suicidal impulses, pre- 
cordial panic, morbid fears, hallucinations and illusions. 
Of physical symptoms may be mentioned, headache, 
insomnia, muscular inertia, and partial or complete loss 
of sexual appetite, coupled with malnutrition and loss 
of weight. Treatment similar to that of Hypochond- 
riasis— Arsenic or Aurum (p. 9) ; Brom, Camphora, Castor. 
(pp. 25-29); Galvanism (p. 148), etc. 

Meningitis — The inflammation of the pia mater and 
arachnoidea is called Leptomeningitis; that of the dura 
mater, Pachymeningitis (see Brain). Pachymeningitis 
is always suppurative, following injury or disease of the 
cranial bones, especially otitis interna et media, with 
consecutive caries of the petrous portion of the temporal 



Meningitis. 307 

bone. The treatment is surgical and directed to the cause. 

Internal Hemorrhagic Pachgmen myitis is characterized 
by a more or less slow hemorrhage, preceded generally 
by symptoms of antecedent cerebral disease, as head- 
ache, vertigo, tinnitus aurium, intolerance of light, with 
contraction of pupil, and insomnia. If the hemorrhage 
be sudden and considerable— apoplexy — it may prove 
fatal; if it take place slowly, it will cause somnolence, 
the mind, on awaking, being more or less disordered. 
>uch an attack of apoplectic coma may occur more than 
once, and may last for days. The limitation of the 
haematoma to one side may produce facial paralysis or 
hemiplegia, muscular contractions or convulsions, or 
only contraction of the pupils. The disease, which 
occurs mostly in old age — drunkards being particularly 
liable to it — is, aside from trauma, incident to chronic 
lesions of the brain, especially to those belonging to 
general cerebral paralysis. The treatment consists in 
cold compresses to the head; stimulating pediluvia (419); 
counter-irritation to the neck, and cathartics (p. 88). 
Brom (p. 25), or Ergot (pp. 65 & 78) may be tried, and 
to promote absorption, Iodine (p. 14). 

Leptomeningitis — Simple acute cerebral meningitis, 
exclusive of its occurrence in the course of eruptive 
fevers, pneumonia, etc., developes sometimes with in- 
flammation of the dura mater, in connection with dis- 
e of the middle ear; though, in cases of otitis interna, 
it may be developed without either, pachymeningitis 
or caries. It is characterized by great excitement, 
eventuating even in hilarious or maniacal delirium; in- 
tense headache; intolerance of light and sound; flushed 
countenance; strongly pulsating carotids; vomiting, and 



308 Meningitis. 

more or less fever. These symptoms are followed by 
the stage of oppression: Drowsiness; rapid and feeble 
pulse; Cheyne- Stokes respiration^ spasmodic twiteh- 
ings and paralysis facialis or hemiplegia, passing (in 
fatal cases) into coma. Strabismus, hemiplegia and 
convulsions are not absolutely of bad omen. Treatment 
similar to that of the preceding disease, the ice -cap or 
cold douche to head; sinapisms to neck; and Calomel and 
Jalap, or Croton (pp. 92 & 98); or Aconite (pp. 22 & 55). 
To diminish the cerebral excitement, Brom, with or with- 
out Morphia, In the second stage, Iodine as sorbefacient, 
and a blister to nuca, if required. Attention to bladder 
and supporting measures are other important items. 

Meningitis tuberculosa — Basilar Meningitis or Acute 
Hydrocephalus (for the chronic form see Hydrocephalus) 
occurs chiefly in children of, from 2 — 7 years of age. It 
is characterized by the presence of miliary tubercles in 
the pia mater, conjoined with meningeal inflammation 
and a serous effusion in the ventricles. Unless super- 
vening upon tubercular disease of the lungs, it is usual- 
ly preceded by general indisposition, muscular debil- 
ity, pallor and irritability of temper. The disease be- 
gins mostly with frontal headache, fever and vomiting, 
in fact all the symptoms of simple meningitis; and a 
lancinating pain, causing infants to utter from time to 
time a sudden, sharp cry, known as the cephalic cry. 
The second stage is marked by somnolency, with occa- 
sional delirium; the pupils dilate; the eyelids are but 
partially closed; and sometimes there is strabismus. 
Subsultus, carphologia and paralysis or convulsions gen- 
erally close the scene. The treatment is similar to that of 
simple meningitis, though without much hope for success. 



PART II. 



CONTINUATION. 



Meningitis cerebro-spinalis is an essential fever of an 
infectious nature, the inflammation of the meninges be- 
ing a local manifestation of a general morbid condition. 
It is characterized by severe headache with spinal pain 
and hyperesthesia of the whole body, to a degree that 
renders the slightest touch unsupportable, in conjunc- 
tion with contractions of the muscles of the neck and re- 
traction of the head. In addition there are chills, nau- 
sea and vomiting; paroxysms of delirium, especially at 
night, and accompanied by hallucinations; finally great 
prostration, followed by coma. Deafness and blindness 
are occasional sequels, if the disease does not end fa- 
tally — the latter from purulent choroiditis, the former a 
result from purulent inflammation of the labyrinth of 
the ear. Treatment according to the severity of the 
disease — wet cups to the neck; or leeches behind the ear; 
andcoA/ applications with Quinine (7); or Aconite (pp. 22 

(309) 



310 Menopause. 

& 55); Pulsatilla (p. 16); Ergot (p. 78); Brom, Chloral, 
G else mi urn or Opium (pp. 25-38) or Morphine hypoder- 
mically (p. 110). As support, brandy (p. 73). 

Menopause — The final cessation of menses where 
the ovaries get into a state of atrophy, and women fre- 
quently grow in flesh, represents the so-called critical 
time of female life, inasmuch, aside from any tendency 
to cancer (either of the breast or of the womb, which 
will have been held in check by the catamenia); or any 
predisposition to apoplexy; or engorgement of some or- 
gan, all of which are more liable to be developed at this 
time, where the derivative effect of the monthly loss of 
blood necessarily stops, we usually meet with disturb- 
ances in the economy, which are of more or less import- 
ance, and in the treatment of which we have always to 
bear in mind this cause. Exclusive from irregularities 
of the molimia, which may be extremely profuse or very 
scanty; suspected to reappear after several months, or 
replaced by a leucorrhceal discharge; in connection with 
uterine disease or no, we will find at the climacteric 
period the most varied affections, all standing in some 
relation with the organs of generation — asthma, palpi- 
tation of the heart, haemoptysis, etc.; often the nervous 
system is imminently excited, producing paralysis of all 
grades and convulsions of all shades — catalepsy, epilep- 
sy, chorea, hysteria, even mania. The treatmenthas ref- 
erence to the causative disease, amenorrhoea, metrorrha- 
gia, uterine disease, etc. Compare Menstruatio vicaria. 

Menorrhagia (Profuse menstruation). See Hemor- 
rhage from the uterus ; for Difficult Menstruation, and Re- 
tention or Suppression of Menses see Dysmenorrhea 
resp. Amenorrhoea. 



Menstruatio. 311 

Menstruatio yicaria is the hemorrhage from any 
organ, taking the place of the physiological discharge of 
blood from the uterus. The bleeding may come from 
the bowels, stomach or bladder; from the nose, mouth 
or bronchial tubes; even from the umbilicus or from 
hemorrhoids or ulcers. Sometimes the molimia are re- 
placed by abundant salivation, leucorrhoea or periodical 
eruptions; but the intestinal mucous membrane is the 
one which most frequently affords the vicarious discharge 
as diarrhoea. For a time, women are protected against 
the effects of suppressed menstruation by the increased 
deposit of fat in the various tissues, thereby preventing 
local engorgement, especially at the climacteric period. 
The treatment consists in breaking up, if possible, the 
faulty determination and stimulating at the same time the 
uterus: Aloes cum Myrrha (p. 89) every 2d or 3d night 
and a saline draught (p. 95) in the morning in case of 
constipation; together with styptic pediluvia (419), etc. 
Some blood, (about 2 ounces) may betaken from the arm 
at the period of menstruation and if required to be re- 
peated for several months in succession. 

Mentagra (Tinea Sycosis). See Head. 

Mental depression. See Melancholia and Hypo- 
chondriosis. Mental Diseases — Insanity. 

Meteorismus. See Tympanites. 

Metritis interna and parenchymatosa. See Uterus. 
(Endometritis resp. Hyperplasia.) 

Metrorrhagia. See Hemorrhage from the Uterus. 

Micturition, painful (Strangury). See Bladder, resp- 
Kidney, (Cystitis, Spasmus Vesicae and Nephritis acuta)* 

Migraine. See Cephalalgia. 

Milk leg. See Phlegmasia alba dolens. 



312 Mole. 

Miscarriage. See Labor (premature). 

Mole (Mothermark), See Nsevus. 

Mole, uterine — True moles, the vesicular or hydati- 
form are clue to an alteration in the envelops of the 
ovum, together with an irregular enlargement of the cho- 
rial villosities. The false mole is not necessarily con- 
nected with pregnancy, and is often represented by po- 
lypoid and fibrous growths, or membranes of conges- 
tive dysmenorrhea. In connection with pregnancy, the 
whole or part of the frontal shell, or of the placenta is 
retained and more or less organized within the uterus, 
after the life of the foetus has been destroyed by ad- 
verse influences, without being expelled properly. It is 
characterized by cessation of the signs of pregnancy, he- 
morrhage w T ith uterine tenesmus and a feeling of weight. 
Treatment— After full dilatation (by tents if necessary) 
of the cervix, uterine action should be roused by the 
persistent use of Ergot (p. 65). Or the mass may be re- 
moved by a large uterine scoop, or by traction with the 
placental forceps. 

Morbilli (Measles) — A contagious fever chiefly oc- 
curring in childhood of mostly a mild form; but sometimes 
associated with grave complications, as capillary bronchi- 
tis, croup, diphtheria, etc., or followed by no less serious 
diseases. It is characterized by an eruption, preceded 
sometimes by an eclamptic fit, but generally by more or 
less catarrh of the air passages, coryza and conjunctivitis 
with feverishness constituting the most prominent 
symptoms. The rash appears first on the forehead, in- 
vades face and neck, and spreads within two days over 
nearly every part of the body, the slowness of the ex- 
tension being distinctive from scarlatina and variola; 



Mouth. 313 

though the papules into which the spots soon are trans- 
formed, resemble those of the latter disease prior to 
their turning into vesicles. After four days the erup- 
tion, which is sometimes uniformly diffused over the 
whole body, and which may be accompanied with pruri- 
tus, begins to fade again. In severe forms the phenom- 
ena of purpura supervene, and if there be hemorrhage 
from nose and mouth, or from the bowels, it takes the 
name of hemorrhagic measles. Treatment is symptomat- 
ic: According to the degree of pyrexia sponging with 
cold or tepid water, or the wet sheet (420); else Aconite 
(p. 22) Nitre or Soda (pp. 54 &56); for cough, Opium 
(p. 52) and in suppression of rash, Ammonium (p. 43) 
with Mustard bath (419). 

Morbus Bebidorum {Kater). See Alcoholism. 

Morbus maculosus Werlhofii. See Purpura. 

Morbus nauticus — Seasickness occurring in other- 
wise perfectly healthy people when on the water and pro- 
duced sometimes already by the slight motion of a boat 
is characterized by general malaise, nausea with or with- 
out vomiting; hyperesthesia of some nerves especially 
of the olfactory and occasionally by extreme prostra- 
tion. Treatment — Aside from spirits, oranges and apples, 
which are the usual remedies employed on board ship, 
Cocaine (p. 11) or Chloroform (61 & 246) may be tried. 

Mortification. See Necrosis. 

Mouth. Stomatitis simplex — A circumscribed in- 
flammation of the mucous membrane in form of small 
white specks, which are slightly elevated and surround- 
ed by a dark red zone, terminating in white sloughs. 
(The follicles are not involved). Aphthae accompany 
frequently indigestion, and in women menstruation; 



314 Mouth. 

sometimes they are due to smoking and chewing of to- 
bacco; mostly however they occur in children, during 
dentition, from want of cleanliness. Treatment accord- 
ing to cause — In children, Magnesia (112) to correct the 
acidity of the stomach and Borax (284) locally. Muguet 
or Soor (Stomatomycosis) is very similar in appearance, 
being characterized by a whitish exudation in shape of min- 
ute points; they are produced by a fungus — Oidium albi- 
cans — -which is developed in the follicles. Thrush occurs 
chiefly in infants duringihe first few weeks if the mouth 
has not been washed after feeding; in adults it is a sign 
of a cachectic state of the blood. Treatment as in stom- 
atitis simplex; if obstinate, caustic with attention to the 
constitution: Potass (31). 

Stomatitis ulcerosa, Stomacace or Gingivitis paren- 
cliymatosa occurs seldom primary (from bad air and 
food, etc.); usually it is secondary. The most severe 
form, being generally due to the abuse of mercury, is 
characterized by swelling and inflammation of the sali- 
vary glands, cheeks, tongue and fauces, with bleeding 
and sloughing of the gums, accompanied by a flow of pe- 
culiar fetid saliva. Treatment — The best local applica- 
tions are gargles of brandy and water; Phenol, Potassii 
Chloras, Myrrha or Tannin (283, 98 & 300) and Iodine with 
bark (p. 14) internally with occasionally & purgative. 

Stomatitis gangrenosa s. Cancrum Oris — Noma, oc- 
curring chiefly in illfed children, and after infectious 
diseases, begins sometimes as a black spot of gangrene 
on the lip, or inside the mouth, without any inflamma- 
tion, the parts around being pale and wax-like; general- 
ly, however, it commences with a shallow circumscribed 
ulcer, accompanied by swelling of the face, saliva mix- 



Ranula. 315 

ed with blood, and fetid breath. Soon it becomes gan- 
grenous, destroying cheek and gums; the teeth drop 
out and typhoid symptoms supervene, terminating in 
death. Treatment — A purgative (p. 88), followed by 
tonics, Quinine, mineral acids (p. 76), etc; Potassii Chloras 
(p. 56). As lotion, Creosote, Phenol or Zinc (337 & 08); 
or Acid, nitric. (372). The application of Sublim. (1 :5000) 
after having cut the sloughs away, as far as possible, 
with scissors, is said to have been successfully employ- 
ed. The dressing should be renewed every twelve hours, 
until the surfaces are clear and healthy, when it has to 
be discontinued. 

Glossitis — Inflammation of the tongue accompanied 
by great swelling, tenderness and difficulty in speaking 
and deglutition, is generally caused by profuse saliva- 
tion. Treatment as in stomatitis ulcerosa: A purgative 
and gargles; if necessary leeches or incisions. 

Parulis — Gum-boil, a small abscess, forming in the 
socket of a tooth, and bursting through the alveolus and 
gum, sometimes through the cheek, is caused usually by 
the irritation of a decayed tooth. Treatment — Removal 
of the tooth if much decayed, and fomentations; as soon 
as matter is detected, an incision. If the gum next to a 
decayed tooth becomes spongy, swelled and sensitive, 
the incision should be made too. Aperients (p. 88) and 
an astringent mouth-wash (299) will be of service. 

Hamda, an encysted tumor under the tongue, may, if 
the cyst be loosely attached, be dissected out; or a piece 
of the eac may be cut out ; or simply a free incision may 
be made, and the interior touched with caustic. Epulis 
is a fibrous or myeloid tumor, flat, prominent or pendu- 
lous, and painless, growing from the internal or exter- 



316 Mouth. 

nal surface of the gum; or from the periosteum, covering 
the alveoli between two teeth, which latter ultimately 
will be displaced. It should be extirpated at once, even 
if the tooth on either side has to be extracted. Cancer 
commences with a nodule, which is nearly always situa- 
ted on the edge of the tongue — Free and early extirpation. 
Tongue-tie is a congenital shortening of the frcenum 
linguce, confining the apex of the organ to the lower jaw. 
The fraenum must be divided with a blunt-pointed pair 
of scissors, taking care to direct their points downwards 
close to the jaw, so as to avoid the ranine artery. 

Fetor Oris seu Stomatodysodia — Offensive breath is 
either due to catarrhal affections of the respiratory or- 
gans, chronic pulmonary disease, digestive derangement; 
or to caries of teeth and want of cleanliness. Removal 
of cause, if possible, and disinfecting gargles (283 & 298). 
For Salivation (a morbidly increased secretion of sali- 
va) see Stomatitis ulcerosa, page 314. 

Muguet (Stomatomycosis). Seepage 314. 
Mumps. See Parotitis. 

Myalgia — Muscular Rheumatism is a neuralgia, af- 
fecting sensory nerves in muscular organs, characterized 
by more or less tenderness, extending over the whole sur- 
face of the affected muscle, and not limited to certain 
points as in ordinary neuralgia; and by the fact that par- 
oxysms of pain are more or less cramp-like and excited 
exclusively by movements of the affected muscle — A dia- 
gnostic feature of abdominal myalgia is, that firm pres- 
sure with the palm of the hand can be well borne. (My- 
algia in the exlremeties must not be confounded with 
neuralgia affecting the nervous trunks, or with syphili- 
tic rheumatism). If the muscles of the anterolateral 



Ncevus. 317 

part of the neck are affected, it is called rheumatic tor- 
ticollis, if of the posterior part, cermcodynia\ if of the 
back, dorsodynia; if of the loins, lumbodynia or lumba- 
go', if of the thoracic muscles, pleurodynia^ shoulders, 
scapidodynia; coccyx, cocciodynia. This last affection, 
which is characterized by severe pain upon sitting down 
or rising, especially from a low chair, and defecation; 
and which is to be discriminated from painful hemor- 
rhoids, fissure of anus, and a spasmodic condition about 
the muscles of this part, due to worms in the rectum, aris- 
es frequently from uterine disease. Treatment — In acute 
cases, next to rest sinapisms and soothing embrocations, 
Belladonna, Aconite, Chloroform (350, 410 & 11) etc.; or 
Phenol or Morphium hypodermically (pp. 107 & 1 10). In- 
ternally Am mon. Chlor. in one-half drachm doses (p. 44); 
Salicin (p. 18); Quinine (p. 11) in full doses; with an- 
odynes, Brom, Gelsemium, Morphium, Lithium (pp. 26, 33, 
37 & 51). In the chronic form aside from the above 
treatment stimulating liniments (409); or Lugol's paint 
(p. 15). Small blisters (408) do sometimes good. Elec- 
tricity or the pack (420 & 21) may be tried; Ferrum 
(p 79) if anaemia. In coccyodynia extirpation of the 
bone, if nothing should effect a cure. 

Myelitis. See Spine. 

Myopia. See Eye. 

Njevtjs — A mole or mother's-mark is a simple angio- 
ma of a red color, if arterial; dark or bluish if venous. 
It is generally congenital and harmless. Galvanopunc- 
tiure (p. 149). The cavernous angioma is an erectile tu- 
mor, and the villous variety is a vascular growth most- 
ly to be found at the neck of the bladder. See Ure- 
thral Tumor. 



318 Nails. 

Nails — A very common and troublesome affection, 
which usually occurs by the side of the great toe, is in- 
growth of the nail. The contiguous soft parts are first 
swelled and inflamed by constant pressure against the 
edge of the nail from the use of tight shoes, and soon 
an ulcer is formed, with fungous and exquisitely sensi- 
tive granulations, in which the edge of the nail is em- 
bedded, often producing so much pain as to prevent 
walking. Treatment— In most cases, if the nail having 
been well softened by soaking in warm water, is shaved 
as thin as possible with a sharp knife, and the pain and 
irritation allayed by rest, with fomentations; any ulcer 
that has formed will heal with the aid of black-wash 
(329) on lint, or a touch of lunar caustic. Afterward it 
is useful to cut out of the middle of its free edge a 
V-shaped piece, reaching down to the quick, but not in- 
to it, so as to permit the nail to be bent up vertically 
from the sides, and thus yield to the lateral pressure. 
Or the interstices between the nail and the granulations 
may be brushed several times a day with a solution of 
Gutta percha in Chloroform (1 : 8), until the nail is lift- 
ed from the underlying parts; when it can easily be cut 
off with scissors. The gutta percha of the anaesthetic 
menstruum is said to force its way between the granu- 
lations and the nail, thus liberating it from its abnor- 
mal position. 

Exostosis — A fibrous tumor (which sooner or later os- 
sifies), on the dorsal surface of the last phalanx of the 
great toe. To cut away a sufficient portion of the nail, 
and dissect the tumor out, separating it deeply from the 
phalanx by means of bone forceps, or amputation of 
the toe, is the only effective treatment. For knotty and 



Neuralgia, 319 

brittle nails ( Onychomycosis) see Tinea tonsurans, page 
247; and for inflammation at the root of the finger- 
nail — Onychia. 

Nausea. See vomiting. 

Necrosis — Death or mortification of bone, especially 
the shaft of a cylindrical one which is inclosed in a case 
of new bone, is due to injury or violent inflammation. 
Necrosis of the superficial layer of bone is called exfo- 
liation. Treatment — As soon as the diseased part (se- 
questrum) is sufficiently loose, it has to be removed. See 
Gangrene. 

Neoplasma. See Skin (Hypertrophy), 

Nephritis. See Kidney. 

Nervousness. See Hysteria. 

Nervous Exhaustion or Prostration (Neurasthe- 
nia). See Debility. 

Nettlerash. See Skin. 

Neuralgia — A functional affection of nerve-trunks 
or their branches, characterized by morbid sensibility, 
and shifting excruciating pain, which occurs in parox- 
ysms, or marked exacerbations, accompanied by tender- 
ness in certain circumscribed spaces of the skin, and due 
among other causes to anaemia, malaria, gouty and rheu- 
matic dyscrasiae. Trifacial Neuralgia or Prosopalgia is 
characterized by pain situated in the sensory fibres of 
the quintus and is generally unilateral: If the supra-or- 
bitalis is affected, there will be moreover intolerence of 
light with redness of the eye and increase of tears (mi- 
graine, hemicrania or brow-ague); in neuralgia of the 
2d branch (N. maxillaris superior)^ there is increased se- 
cretion of one nostril, accompanied by heat; and if the 3d 
be affected, there will probably be more or less saliva- 



320 Neuralgia. 

tion. A very obstinate form of facial neuralgia is char- 
acterized by spasmodic contraction of the muscles of 
the face, hence the French name tic douloureux. Cer- 
vico- Occipital Neuralgia is characterized by shooting 
pains, starting from the cervical vertebrae just below the 
occiput and extending thence over the posterior and su- 
perior portion of the cranium as far as the ear. Cervi- 
co-Brachial Neuralgia is generally limited to either the 
ulnar, radial, median or musculo-cutaneous. In Crural 
Neuralgia there is a shooting pain along the anterior cru- 
ral nerve and its branches. In Sciatica, the neuralgia 
is of a rheumatic nature (see Myalgia), and sometimes 
associated with muscular twitchings and cramps. The 
most painful parts of the sciatic nerve are generally at 
the sacroiliac junction, behind the trochanter major, at 
the head of the fibula, and the external malleolus. Hys- 
terical Neuralgia is in most cases easily diagnosticated 
on account of its anomalous character: A woman may 
complain of an unsupportable pain in the chest or side, 
yet she will expand her ribs freely \ or of the severest 
pain in any part of her body, yet she will easily bear 
pressure. For Visceral Neuralgia see the organ which 
is the seat of the disease. Treatment — Aside from due 
attention to the causative disease, a generous diet, and 
proper hygienic measures, anodynes will be of most im- 
portance: Aconite, Belladonna, Brom (35, 43 & 50); Chlo- 
ral, Chloroform and Hyoscyamus (60, 64 & IS) Conium or 
Morphium hypoderm. (245 — 255). Locally, Aconite, Ver- 
atrin or Camphora (409 & 10); Opium, Bell., or Chloroform 
(350 & 52); small blisters successively applied to the ten- 
der points (408); the actual cautery or electricity, espec- 
ially cutaneous Faradization (p. 149). Weak nerve irri- 



Neuritis. 321 

tation of any part in the body, but particularly, if caus- 
ed by slight urinary affections as lithiasis, grit or con- 
gestion of the kidneys, is said to be easily subdued by 
a few drops of Cocaine (20#) 3 injected into the urethra — 
in severe neuralgia, as the pain produced by stone, in- 
flammatory diseases, or cancer, it is of no value what- 
ever. One or the other of the following remedies will 
also sometimes afford relief: Arsenic, Quinine, Rhus (pp. 
9, 10 <fc58); Terebinthina, Argentum, Phosphor (pp. 68,74 
& 85); Strychnine and Zinc (184, 194 & 96). In addi- 
tion to these may be mentioned Ammonium internally 
and locally (p. 44); Pilocarpin, Cuprum (pp. 51 & 78); 
Iodoform -Collodium (1 : 10), brushed over the painful part, 
until it forms a thick cover, in trifacial neuralgia; or 
Amyl (37 & 308); in sciatica, Iodine and Colchicum (pp. 
14 & 48). In the hysterical form are occasionally of 
service, Cannabis, Cocaine and Ferrum (57, 168 & 173); 
Camphora (56 & 243); or Cimicifuga (p. 47). 

Neurasthenia. See Debility. 

Neuritis— If a superficial nerve is inflamed, it may 
be felt hard like a cord, and the skin over it, red, even- 
tuating sometimes in erythema or vesicular eruption. 
The pain of an inflamed sensory nerve may extend to its 
terminal branches, and the inflammation may be follow- 
ed by anaesthesia with or without analgesia. If seated 
in a motor nerve, it may give rise to muscular contrac- 
tions, followed by paralysis, which if there be ako loss 
of reflex and of electrical conduction, will lead to atro- 
phy of the affected muscles. Neuritis is mostly due to 
injury or the presence of foreign bodies. The treatment 
of the idiopathic affection consists in soothing and revul- 
sive applications (409 & 10) with or without Morphinum 



322 Neuroma, 

hypodermically (p. 109). The anaesthesia or paralysis 
which may follow, requires electricity (p. 148). 

Neuroma is called any tumor growing from the 
sheath of a nerve. It is generally painless, but if it 
proves troublesome, it may be extirpated, provided the 
connection is not so intimate as to require division, 
which in a large nerve, such as the sciatic, would be 
followed by paralysis of the limb. A painful subcuta- 
neous tumor, of the size of a pea, generally affecting 
women, and associated frequently with hysterical and 
spasmodic affections, though fibrous, and visibly not con- 
nected with a nerve, is called neuroma on account of its 
being subject to fits of a most severe neuralgic pain. 

Neuroses. See Epilepsy, Chorea, Hysteria, etc. 

Nightsweat. See Ephidrosis. 

Nipples. Sore. See Breast. 

Nocturnal Emissions. See Impotenz. 

Nodes (Gummata). See Syphilis. 

Noma. See Mouth and Vulva (Stomatitis, resp. Vul- 
vitis gangrenosa). 

Nose — Foreign bodies may be removed by a small 
scoop or bent eye-probe, and if they- cannot be brought 
through the nostrils, they may be pushed back into the 
throat. Ifaj»(9^9present(whichsometimesmay be brought 
into view by blowing strongly through the affected nos- 
tril, whilst the other is closed with the fingers), there 
will be a constant feeling of stuffing and cold in the 
head. The treatment consists in injections of Sangui- 
naria or Phenol (239 & 291) into the substance of the 
growth; or in twisting it off with polypus or dressing 
forceps, after having ascertained its neck by means of a 
probe. If it should project backward into the pharynx 



Ozcena. 323 

it must be extracted through the mouth with curved 
forceps; or a loop of stout twine may be passed by means 
of a bougie, along the floor of the nostril into the phar- 
ynx, where it may be passed around the tumor by the 
fingers; and the tumor maybe dragged forwards through 
the nostril. Cancerous growth maybe diagnosticated if 
there is a freely bleeding fungoid surface, pain, and 
signs of cachexia. 

Cort/za, Rhinitis catarrhalis or Cold in the Head 
(Schnupfen of the Germans) — An inflammation of the 
Schneider ian membrane, yielding a copious discharge, 
extends often to the conjunctiva, producing watering of 
the eye; sometimes it spreads upwards, occasioning fron- 
tal headache or a pain confined to the bridge of the nose; 
sometimes the Eustachian tubes become involved, pro- 
ducing noises in the ear or partial deafness. If compli- 
cated with the other air passages it constitues the com- 
mon coW. (See Catarrh). Treatment — Acidum salicy- 
licum gr. xx ter die in Liq. Ammon. acet. (p. 43) has lately 
been recommended as aborting the disease ; however a stiff 
grog before going to bed, and perhaps Infusum Sal vice 
as douche, in case the pharynx be involved, will general- 
ly do the same; else the treatment indicated in bron- 
chitis. The chronic form (Stocks chnupf en), unless aris- 
ing from the acute, is a constitutional dyscrasia. Rhi- 
norrhoea is another form of coryza, characterized by a 
purulent discharge, more or less fetid, and accompany- 
ing or following a common cold, and very obstinate. 
Tonics, especially mineral acids (p. 71) with Phenol (289) 
locally. Ozcena is a horribly fetid, purulent or sanious 
discharge from the nostrils, depending like otorrhoea on 
some morbid condition as scrof ulosis, syphilis, etc. The 



324 Nymphomania. 

treatment has to be directed to the causative disease; 
and locally Argent, nitric. (288) or Acid, chrom., Phenol, 
Mangan (289) etc. For bleeding of the nose (epistaxis), 
see Hemorrhage and Menstruatio vicaria; for neuroses 
of the olfactory, as hyperesthesia (increased sensitive- 
ness), anosmia (loss of smell), and parosmia (perverted 
sensibility) — Hysteria. 

Nymphs, Hypertrophy. See Vulva. 

Nymphomania signifies a morbid and excessive sex- 
ual desire in females — occasionally a phenomenon in hy- 
drophobia. Treatment — Aside from hygienic measures, 
Brom or Camphora (pp. 26 & 28). Salicin (p. 18) has 
been recommended. 

Obesity. See Adipositas. 

Occmsio Ani et Urethra. See Anus, resp. Urethra. 

Odontalgia (Toothache). See Teeth. 

(Edema. See Anasarca; of Glottis — Larynx; Pulmo- 
nary — Lung. 

(Esophagus — Foreign b ydies fixed in the pharynx or 
oesophagus produce a sense of choking, and fits of a suf- 
focative cough, causing if not suffocation at once by 
spasm of the glottis, ulceration of the part, when the 
impaction of the substance takes place, attended by ex- 
hausting cough with dyspnoea and profuse expectora 
tion. A quick and thorough search of the pharynx 
should be made with the finger, the patient being seat- 
ed in a chair, with the head thrown back and the mouth 
wide open. When the substance is felt, but cannot be 
removed by the finger it may probably be done with 
curved forceps guided by it. Pins and fishbones are 
usually entangled about the pillars of the fauces or in 
the folds of mucous membrane between the epiglottis 



(Esophagism. 325 

and tongue. If the body has passed into the oesophagus 
and is small in shape (a fishbone, etc), it may be got 
rid of by making the patient swallow a good mouthful 
of bread. If large and soft (a piece of meat, etc.), it 
may be pushed down with the probang; but large and 
hard bodies, as glass, bone, teeth, and the like, should be 
brought up if possible. If this cannot be done by a con- 
venient instrument, and the stomach is full, it might be 
vomited up with the aid of a dose of Tart, emeticus 
If all means fail, cesophagotomy. If the substance has 
got into the stomach, the sufferer should eat plentifully 
of rice, potatoes, etc., with oil, so that in its further pas- 
sage it may be shielded by plenty of faeces, taking care 
that if it be a copper coin or some other poisonous me- 
tal, not to allow acid drinks. 

Stricture of the CEsop/iagtts, unless due to pressure 
by a tumor and the like from without is generally found 
just below the termination of the pharynx, opposite the 
cricoid cartilage; and consists mostly of a thickening of 
the coats of the oesophagus. Treatment — Aside from 
occasional leeching for the relief of exacerbations of 
pain and spasm, and Conium ovHyoscyamus (pp. 31 & 33), 
if there be much irritability, dilatation with a bougie 
(•297) or a ball '-probang, together with the occasional in- 
troduction of a sponge moistened w T ith a weak solution 
of Arg. nitr. (261). The same treatment is indicated in 
ulceration, which, even without the pre-existence of a 
marked tumor, may affect the pharynx at the base of the 
cricoid cartilage as well as lower down the oesophagus. 

Spasmodic Stricture or GZsophagism, is characterized 
by sudden fits — the patient at a meal finding himself in- 
capable of swallowing; the attempt to do so producing 



326 (Esophagus. 

spasmodic pain and a sense of choking. It depends al- 
ways on a weakened or hysterical state of the system, 
or on the presence of some other disorder; and may last 
for years. Treatment has to be directed to the cause — 
Tonics, antispasmodics and alteratives, especially Ferr. 
c. Aloes (pp. 89 & 90) at bedtime; and the showerbath. 

Palsy of the (Esophagus occasions inability of swal- 
lowing without pain or spasm; andmay follow diphtheria, 
or depend on disease of the brain or spinal cord. Treat- 
ment according to cause. Meanwhile the patient has to 
be fed by nutrient enemata (387); or by the stomach- 
pump (297); or by pushing soft food down the oesopha- 
gus with a probang. 

Onychia — Whitlow is an inflammation of the skin at 
the root of a nail, characterized by swelling and oozing 
of sero-purulent matter from under the skin. If severe 
— Onychia maligna — , an ulcer is formed with swelled, 
jagged edges of a peculiar dusky hue, and a very fetid 
discharge. It is generally due to scrophula or syphilis. 
Treatment accordingly — Iodine (p. 14) and locally Ungt. 
Hydr. rbr. or Arsenic (266 & 400). Paronychia exists 
as cutaneous, subcutaneous, thecal and periosteal ab- 
scess. The first is characterized by inflammation of the 
skin with effusion of a serous or bloody fluid, which 
elevates the cuticle into a bladder; the second, by sup- 
puration at the root of the nail, which may come off. 
Treatment — Aside from purgatives (p. 88) fomentations 
and dressings with Balsam, peruvian., Phenol, or Arsenic 
(398 & 400) — Incision if necessary. 

In periosteal whitlou), consisting in periostitis of a sup- 
purative character, which may lead to necrosis of the 
phalanx; and tendinous whitlow {thecal abscess), affect- 



Ovaries. 327 

ing the tendinous sheath, a free incision should be made 
at once: The knife must be carried deep enough to feel 
the bone and tendon, so as fairly to open the sheath of 
the latter. If matter has extended into the palm, an- 
other incision should be made upon a director — in or- 
der to avoid the digital artery — till the pus freely escapes. 

Oophoritis. See Ovaritis. 

Ophthalmia. See Eye. 

Orchitis. See Testes. 

Os Uteri. See Uterus. 

Otalgia. Otitis. Otorrhcea. See Ear. 

Ovaries — Atrophy may, aside from being a physio- 
logical action constituting the menopause, be the result 
of acute ovaritis, pelvic peritonitis or cellulitis, in which 
case general tonics (p. 69) may be of some use; in con- 
junction with uterine irritation, produced by the intro- 
duction of a tent once or twice a month, provided in- 
flammatory action be not excited; or electricity (p. 149); 
or — marriage. The same treatment is indicated in cases 
of imperfect development of the ovaries. 

Displacement of the Ovaries is not only a consequence 
of any displacement of the uterus — pregnancy — or ab- 
dominal viscera; but will result also from inflammation, 
hypertrophy and other affections of the organ itself, the 
prolapse generally being attended by hernia of the Fal- 
lopian tubes, or some portions of the intestines or omen- 
tum. They mostly fall, when their weight is increased, 
into the cvl-de sac of Douglas; rarely into the inguinal 
canals, or through them into the dartoid sacs of the labia 
mcrjora 9 where they show a monthly intumescence, which 
creates much local disturbance, and keeps the part swell- 
ed, heated and tender until ovulation is passed. Treat- 



328 Ovaries. 

ment — Reposition by iaxis and keeping it in situ by a 
proper truss, pessary or bandage is all that can be done. 
See Chronic Ovaritis, next page. 

Ovaritis acuta is characterized by severe pain in one 
or the other iliac fossa, with increase of heat, fever and 
perhaps chills. By conjoined manipulation the ovary 
is felt enlarged, exquisitely sensitive, and generally de- 
pressed in the pelvis. These symptoms may subside by 
resolution; or pus may be formed in the gland, which 
may discharge into the peritoneum, rectum, vagina or 
bladder. It may be caused by gonorrhoea, and disturb- 
ances of menstruation; but mostly it is associated with 
pelvic peritonitis or cellulitis. Treatment — Aside from 
perfect rest, laeches over the diseased organ, at the 
groin or around the anus. A poultice over the hypogas- 
trium, if its weight give no pain, and Opium freely by 
mouth and rectum (p. 35). The chronic form being 
characterized by a dull pain over one or both of the ova- 
ries, which probably will be augmented by menstrua- 
tion, is, as a primary affection, creating uterine disorder, 
as frequent as it is secondary to uterine disease. In case 
of prolapse there will be pain on sexual intercourse; pain 
in rectum and down the thighs; pain and exhaustion af- 
ter defecation; leucorrhoea, irregular menstruation; and 
sometimes inability to stand or walk. If both ovaries 
are diseased, sterility is the consequence. Whilst in 
some cases the symptoms are entirely physical, in others 
the mind and nervous system will be found much involv- 
ed — epilepsy is often a result. Aside from a deviation 
of the uterus from its normal axis, from the os of which 
a mucous plug generally will protrude, there will be 
found in Douglas' pouch on one or both sides of the 



Tumors. 329 

uterus the ovary as a round, soft body, about the size of 
a walnut, which, when caught between two fingers in 
conjoined manipulation will prove very sensitive, and 
produce often nausea and a tendency to hysteria. Treat- 
ment is generally of no avail, though in time recovery 
may take place. If the ovaries be prolapsed, they may 
be sustained by a light ring pessary; and if the displac- 
ed uterus press upon them, it should be kept in position. 
At the same time anodynes, Brom (p. 24) etc., and coun- 
terirritation (409); with vagina/ injections if necessary 
(358 et seq.). Sexual intercourse should be limited. 

Ovakiast Tumors are either solid (fibroma, carcinoma) 9 
or cystic (cysto- fibroma or sarcoma, cysto- carcinoma, der- 
moid cysts, ovarian cysts, and cystomata). They must 
not be confounded with pelvic cysts, which closely re- 
semble them, nor with other abdominal enlargements. 
Treatment — Ovariotomy if practicable, constitutes in most 
cases the radical cure — it is the last resource and gener- 
ally the only one left. In ovarian dropsy tapping (p. 144) 
may be resorted to, either through the linea alba, mid- 
way between the symphysis pubis and umbilicus, or 
through the linea semilunaris, according to the position 
of the most depending part of the tumor, or per vagi- 
nam, if it has descended so far, that fluctuation may be 
recognized there. Previous to the operation a broad 
bandage should be placed around the abdomen — if the 
patient be in the sitting posture — and tightened in pro- 
portion as the fluid escapes, to give support to the abdo- 
men; but especially to prevent syncope from too sudden 
a passage of blood from the brain. If the linea alba is 
chosen for paracentesis, the bladder must have been evac- 
uated; and care has to be taken not to thrust the trocar 



330 Ovaries. 

into a plexus of veins, which is not uncommon on the 
abdominal surface — the engorgement being produced by 
obstructed circulation, — or the intestines, which might 
intervene between the abdominal wall and outer sur- 
face of the ovary — to be readily ascertained by the ab- 
sence of resonance on percussion. In choosing on the 
other hand, the linea semilunaris, the epigrastric artery, 
which passes obliquely upward toward the umbilicus, 
and the pulsations of which generally can be made out, 
is to be avoided. In case the vagina should be preferred, 
a curved trocar has to be introduced into that organ, 
along the fingerf and the ovary penetrated just behind 
the cervix Uteri, taking care to direct the instrument as 
it enters the tumor, upward, in order to avoid injury to 
either the uterus or rectum. The end of the canula must 
be left in the ovary, and so fastened as to allow the free 
escape of the fluid. Afterwards an embrocation of Digi- 
talis (413) to the abdomen with a view of increasing 
diuresis, and occasionally Gamboge (p. 91) to regulate 
the bowels. Sometimes a tumor may be found in the 
triangular fossa between womb and rectum, too small 
to detect fluctuation. Six leeches applied to the tumor, 
either in the iliac fossa or in the vagina once a fortnight 
in conjunction with salines (p. 95); and a nitric acid is- 
sue upon the side of the sacrum, may not only check the 
growth, but diminish its size. Patting the tumor with 
the fingers several times a day, and internally muriate of 
lime is said to reduce it also. 

Oxaluria. See Urinary Deposits. 

Oxyukis vermicularis. See Helminthiasis. 

Oz^ena. See Nose. 

Palpitation. See Heart. 



Paraplegia. 331 

Palsy, Shaking. See Tremor; for Palsy of the 
tongue — Paralysis of the ninth nerve, page 337. 

Panaritium. See Onychia. 

Paralysis, which may affect both, sensory and mo- 
tor nerves, signifies more or less loss of either, sensibili- 
ty or of voluntary motion. Complete loss of sensibili- 
ty is anaesthesia; but if the sensibility to pain be only 
lost, whilst, with regard to the other impressions , as heat 
or cold, it remains normal, it is called analgesia — as may 
be observed sometimes e. g. in disease of the spine or 
lead poisoning. Again, paralysis of motor nerves (akin- 
esis) is paralysis par excellence, if complete; but if the 
power of motion be only impaired, it is called paresis. 
The various forms of paralysis are either functional, or 
thfey are due to inflammatory or structural lesions, which, 
if situated in the brain or spinal cord, are known as cen- 
tral \ if without, peripheral. In the former reflex and 
electrical excitability are preserved, whilst in the latter 
they are soon lost, and the affected muscles rapidly be- 
come atrophied. Hemiplegia is unilateral, the paraly- 
sis affecting the side opposite to the one of the brain, in 
which the lesion is seated. If functional, it may be hys- ' 
terical, or follow neuroses as epilepsy, chorea and the 
like, even mental excitement, and will generally disap- 
pear in a few days. 

Paraplegta is mostly a consequence of spinal disease, 
the lower extremities being paralyzed, if the lumbar 
portion be affected; whilst a disease higher up in the cer- 
vical portion will involve the upper extremities. Func- 
tional paraplegia is the most frequent form of hysteri- 
cal paralysis, as it often stands in causative relation to 
diseases of the uterus and ovaries. 



332 Paralysis. 

Acute Ascending Paralysis is characterized by paresis, 
beginning in the feet, becoming gradually complete pa- 
ralysis, and extending successively over the whole limbs, 
the trunk and upper extremities. The respiratory mus- 
cles become affected, producing dyspnoea, followed soon 
by those concerned in speech, mastication and degluti- 
tion; but the bladder and rectum are not involved, and 
the intellect remains intact. The disease, the etiology 
of which has yet to be found out, proves generally fatal 
in a couple of weeks. Treatment — Aside from sustain- 
ing nourishment in conjunction with alcohol (p. 72); gal- 
vanism (p. 148) or the wet pack (420); or Strychnine 
(184) and Iodine (p. 14). 

Bulbar or Glosso-Labio- Laryngeal Paralysis, being 
due to morbid changes in the medulla oblongata, even- 
tuating in atrophy and the disappearance of motor gang- 
lion-cells in this situation, is always chronic, and fre- 
quently combined with progressive muscular atrophy. 
It is characterized by progressive diminution of volun- 
tary power over the tongue and the muscles of the palate 
and lips, so that speech becomes impossible, deglutition 
* more and more difficult, food and drink being often re- 
turned through the nostrils; whilst the face assumes an 
expression, as if about to weep. By degrees the laryn- 
geal muscles become paralyzed, causing aphonia; and 
paresis of the muscles of respiration may soon follow. 
Treatment is as hopeless as in the preceding disease. 
Electricity, Argentum (160); Phosphor (189); Iodine (p. 14); 
Belladonna (p. 23); Ergot (p. 78) are generally employed. 
When deglutition becomes very difficult, good nutrition, 
which is of most importance, must be accomplished by 
means of an cesophagal tube (297) or per rectum (387). 



Pa?rrft/sis. 333 

In the acute form caused by embolism or thrombosis of 
branches of the vertebral arteries going to the medulla 
oblongata, or of hemorrhage in this situation, a success- 
ful treatment has better chances. 

General Paralysis {Dementia paralytica) — The pa- 
ralysis of the insane is a structural affection of the brain 
characterized by an incomplete paralysis — hence, also 
called general paresis — and associated with extravagant 
delusions leading to more or less complete dementia. 
It is supposed to be due to moral shocks, as loss of 
friends, bankruptcy, remorse, etc., however it has been 
attributed also to intemperance. Treatment can be but 
palliative, and as proper attention to diet and hygiene 
are of most importance, an asylum for the insane is per- 
haps the best place for its execution. The Calabar bean 
(256) has been recommended. 

Spinal General Paralysis — Exclusive the paralysis of 
the insane, general paralysis is spinal, and if functional, 
it may be connected with hysteria, or it may be due to 
cold, exhaustion, etc.; sometimes it is a sequel of diph- 
theria. The muscles of all the limbs may be simulta- 
neously or successively affected; and the paralysis may 
be complete, or there may be different degrees of pare- 
sis, with or without anaesthesia. If there is insanity, it 
is accidental; and the facial muscles are not affected. 
Recovery may take place in a few days, but generally 
it takes many months. The treatment of functional 
paralysis involves a due regard to ana?mia and exhaus- 
tion, or cystitis, phymosis and other local diseases sus- 
pected to stand in causative relation by means of reflex 
action or otherwise. Aside from this, electricity (p. 148), 
massage and frictions with stimulating embrocations (409) 



334 Paralysis. 

may be tried. Above all, passive movements, in com- 
plete, and daily exercises of the paralyzed muscles in in- 
complete paralysis. Sometimes douches of alternately 
cold and warm water (420) are useful. Of drugs may 
be mentioned: Strychnine, Phosphor, Sabina, Ergot (p. 69); 
Iodine (p. 14); Mercury (p. 93). 

Spinal Paralysis from acute inflammation of the an- 
terior gray substance {anterior poliomyelitis) is espe- 
cially incident to childhood, and characterized by a sud- 
den fit of fever, accompanied by a pain in the spine and 
extremities, by more or less vertigo, somnolence or 
coma— sometimes by convulsions — and followed invari- 
ably by paralysis, which at first is mostly confined to 
one extremity, though sometimes attacking not only the 
others, but also various muscles of the trunk, without 
however involving sensory nerves. In adults, the cere- 
bral symptoms, which accompany the initial fever are 
less marked, and the paralysis, as a rule, is less obsti- 
nate, though those muscles which do not improve at all, 
become rapidly atrophied. As a number of deformities 
will result from this disease in case the paralysis be per- 
manent, e. g. short limbs, clubfoot, a judicious treatment 
is all important. If the affection be soon enough recog- 
nized, the indications are those of acute myelitis: 
Purgatives (p. 88) in conjunction with cupping or leeching 
and cold applications to the spine; or dry cupping, blis- 
ters (408) and mercurial ointment according to the degree 
of inflammation. Internally, Ergot (p. 78); Belladonna 
(p. 23); Iodine (p. 14), etc. Later, the galvanic current, 
(p. 148), if continued steadily for sometime may restore 
the motor power of the paralyzed muscles, even if their 
susceptibility to the Faradic current have been lost. The 



Paralysis. 335 

pack (420) or massage are sometimes useful. In the 
rest, invigoration of the constitution with tonics (p. 69). 
Atrophic Spinal Paralysis, due to chronic anterior 
poliomyelitis, is characterized by a more gradual devel- 
opment of paralysis, combined with progressive atrophy; 
and though the irregular distribution of the paralyzed 
muscles is analogous to that of the acute form, complete 
recovery is here more likely. From progressive mus- 
cular atrophy it is distinguished by the fact that paraly- 
sis precedes the atrophic degeneration of the muscles, 
in the former the reverse taking place. 

Spas??iodic Sjiinal Paralysis, called also Primary 
Lateral Sclerosis on account of the induration, which 
causes it, affecting the lateral columns of the cord, is 
characterized by tremor, stiffness, and spasmodic twitch- 
ings in addition to the paralysis, with a peculiar hipp- 
ing gait, the feet touching the ground only with the 
toes, as it were, whilst the body is bent forward as 
if about to fall. This spastic gait is distinctive, as 
contrasted with purely paralytic or ataxic gait (lateral 
sclerosis is often combined with posterior spinal sclero- 
sis — see Ataxia). Treatment is like that of other sclero- 
tic affections, galvanism, hydropathy (pp. 146— 149), etc. 
Strychnine is contra-indicated. 
For Paralysis agitans, see Tremor. 

Paralysis from Lead, which is usually preceded by 
lead-colic, may be general, but as a rule only the exten- 
sors of the upper and lower limbs are affected, the for- 
mer being characterized by palsy of the hand, known as 
vrrist-dropy, the latter by dropping at the ankle. The 
treatment has for object the elimination of the poison. 
Iodine (p. 14) etc., see Enteralgia. For the paralysis is 



336 Paralysis. 

indicated the Faracfic current and Strychnine (184). Pa- 
ralysis from Mercury is always preceded by mercurial 
tremor and salivation; and that from Copper by gastro- 
duodenitis. 

Paralysis of the third Nerve is characterized by ptosis, 
diverging strabismus, protrusion of the eyeball, and dila- 
tation| of pupil; and unless connected with cerebral dis- 
ease, may be due to cold, or over-exertion, or to injury 
near the eye. If the paralysis is limited to the upper 
branch of the oculo-motorius, ptosis exists without stra- 
bismus or dilatation of pupil; if, on the other hand, the 
inferior branch alone be affected, there will be strabis- 
mus and dilatation of pupil, without ptosis — in either 
case it will probably be peripheral. Paralysis of the 
fifth Nerve, if accompanied by symptoms denoting brain 
disease, is central; peripheral paralysis — the cause of 
which, though extra-cerebral may be intra cranial — is gen- 
erally characterized by ulceration of the cornea, with red- 
ness and swelling of the face. The motor portion of the tri- 
geminus may be affected either separately or in conjunc- 
tion with the sensory divisions. Bilateral paralysis of the 
motor portion occurs in cases of bulbar paralysis. If the 
motor or third division alone is affected, there will be loss 
of masticating power. If the different sensory branches, 
(the ophthalmic, the superior and inferior maxillary) be 
affected separately, the loss or impairment will be con- 
fined to the portions of skin and mucous membrane sup- 
plied by the branches of the paralyzed division. Paraly- 
sis of the sixth Nerve, which is characterized by con- 
verging strabismus, occurs sometimes in cases of cere- 
bral meningitis and in connection with lesions giving 
rise to hemiplegia. If functional, it may be due to neuri- 



Paralysis. 337 

tis or to syphilis. Paralysis of the Motor portion of 
the seventh pair (Mimetic or Pell's Paralysis), if bilater- 
al — diplegia facialis— is characterized by immobility 
of the whole face, just as if it was covered by a mask. 
If unilateral, only one side is immovable, which con- 
trasts strangely with the sound side, especially in talk- 
ing or smiling; or when the cheeks and lips of the af- 
fected side are puffed outward by each expiration, as 
sometimes will be the case. Facial paralysis accom- 
panied by paralysis of the abducens denotes a central 
lesion, these nerves arising both in the floor of the fourth 
ventricle. The absence of reflex movement is evidence 
that it is peripheral: If winking be not produced by 
touching the eyeball; the sensibility of the latter being 
preserved, it is peripheral; but if the eye be closed in- 
voluntarily by touching the conjunctiva, when the vol- 
untary power is lost, it is central. In cases of facial 
paralysis dependent on neuritis caused by cold, or when 
it is functional, recovery may take place in a few weeks. 
If it continues for 2 — 3 months without improvement, 
it is probably not functional; but if not dependent on 
central lesions, it proceeds from either disease of the 
nerve or something pressing on it, that occasions ob- 
struction. Pandysis of the eighth Nerve affecting some- 
times the pharynx as a sequel of diphtheria, is limited 
to that division, called glossopharyngeal; in conjunction 
with paralysis of the par vugum, it occurs in various 
cerebral diseases, which produce deep coma, causing 
difficult deglutition with slow respiration, and preced- 
ing a fatal termination. Paralysis of the ninth Nerve 
(Palsy of the tongue) on both sides is incident to bulbar 
paralysis, and characterized by inability to articulate, 



338 Parotitis. 

and protrude the tongue. If the hypoglossus be affect- 
ed on one side, the tongue, when protruded will deviate 
from a straight line, its apex pointing to the side of the 
seat of the paralysis. 

Parametritis. See Uterus (Cellulitis). 

Paraphimosis. See Penis. 
. Paraplegia. See Paralysis. 

Paraproctitis. See Proctitis. 

Parkinson's Disease. See Tremor. 

Paronychia. See Onychia. 

Parotitis or Mumps is an infectious and contagious 
disease, being due to some specific poison and occurring 
sometimes epidemically. It is characterized by an in- 
flammatory swelling of the parotis and surrounding con- 
nective tissue, associated usually with headache, fever 
and general malaise. Occasionally the submaxillary 
glands are involved; and in severe cases delirium and 
other cerebral symptoms may be present. As a compli- 
cation of typhus, pneumonitis, etc., suppuration mostly 
takes place. Treatment — The idiopathic form requires, 
aside from a bland diet and purgatives (p. 88), soothing 
fomentations in conjunction with anodynes (p. 20), if the 
pain be considerable. In severe cases, leeches, and Mer- 
cury (p. 13) in alterative doses. 

Parulis (Gumboil). See Mouth. 

Parturition. See Labor. 

Pathophobia. See Hypochondriasis. 

Penis — Phimosis is a constriction of the orifice of the 
foreskin, so that the gians cannot be uncovered with- 
out difficulty, if at all, and is either congenital or caused 
by contracted cicatrices. The radical cure consists in 
circumcision or slitting. In the former, the end of the 



Peritonitis. 339 

foreskin should be drawn out, and being held between 
the blades of a pair of forceps, cut straight off; after 
which the mucous lining of the foreskin must be cut up 
to the corona, so as quite to uncover the glans. In slitt- 
ing, a director may be introduced between the glans 
and prepuce, and a curved pointed bistoury passed along 
the groove. In the adult, 4 or 5 sutures should be made 
through the margin of the incision, so as to draw to- 
gether the edge of the skin and of the mucous lining of 
the prepuce, that they may unite by adhesion. Cocaine 
(330) maybe used as anaesthetic. Paraphimosis is said 
to exist when a tight prepuce is pulled back over the 
glans, constricting it, and causing it to swell. Generally 
it is the result of inflammation following impure con- 
nection. Treatment — The glans well oiled, and covered 
with a bit of lint is compressed with the fingers of one 
hand, so as to squeeze the blood out of it, whilst the 
prepuce is drawn forward with the other. If this should 
fail, the constricting part of the prepuce must be divided. 

Pericarditis. See Heart. 

Perichondritis (Laryngeal) is an inflammation of 
the tissues immediately surrounding the laryngeal car- 
tilages; generally suppurative, culminating in necrosis 
of the cartilage, and as a rule, the result of phthisical 
and syphilitic ulcers. 

Periostitis. See Syphilis. 

Peritonitis — An inflammation of the serous mem- 
brane lining the cavity of the abdomen and covering 
the abdominal viscera, is exclusive the idiopathic form 
from cold, due to a variety of causes, e. g., to perforation 
of the intestines, inflammation of the female generative 
organs, especially during childbed, or to the discharge 



340 Peritonitis. 

of pus, etc., from whatever cause, into the peritoneal 
cavity. The acute form is generally characterized by 
severe pain and great tenderness over the abdomen with 
tympanites and considerable pyrexia (the tympanites, in 
consequence of paralysis of the muscular coat of the in- 
testine may be so great as to produce dyspnoea accom- 
panied by cyanosis). The expression of the face looks 
haggard and pinched, the upper Up if elevated and drawn 
tightly over the teeth, is pathognomic. There is, as a rule, 
extreme prostration and sometimes obstinate singultus. 
On the other hand the disease may be perfectly latent or 
the local symptoms altogether obscured by the presence 
of some other affection. The chronic form being charac- 
terized by exudation, if following acute, may be like the 
latter, idiopathic, and develop insidiously; but usually it 
is secondary to tuberculosis, ascites, and similar diseases. 
Treatment — Locally, turpentine stupes, simple fomenta- 
tions or cold compresses every few minutes, whatever 
most grateful to the sufferer; and Morphine (pp. 36 & 
37) internally, taking care to avoid narcotism. Cathar- 
tics ought not to be given, even if constipation should 
last for a week or more — an accumulation of feces 
may be removed by simple enemata. Quinine (p. 11) 
or Aconite (p. 22) according to the severity of the fever. 
Chloral, Conium, or Hyoscyamus (60, 64 & 73) according 
to circumstances. Alcohol (p. 72) as support. In the 
chronic form the co-existing or causative disease requires 
attention. Pelvic Peritonitis, which may be caused by 
inflammation of adjacent parts — peri-uterine cellulitis, 
endometritis, ovaritis — ; by parturition or abortion, gon- 
orrhoea, uterine colic, etc., etc.; even by the use of tents, 
the uterine sound or injections into the uterus is char- 



Peritonitis. 341 

acterized by all the symptoms, which mark general peri- 
tonitis, only the slighter degree of severity and the 
localization of pain and tenderness pointing to the par- 
tial nature of the affection, excepting some cases, in 
which mental alienation occurs, as this will occasionally 
develop into absolute insanity. At the same time there 
may be felt a swelling in the recto-vaginal space or at 
the side of the uterus, which latter will be more or less 
fixed and displaced. If there be formation of pus, the 
sense of tumefaction or fluctuation may disappear, as this 
discharges itself; but if the effused lymph become or- 
ganized, it remains hard for a long time. Exclusive the 
fixation of the displaced womb, the inflammation may 
result in abscess or atrophy of the ovaries, or oblitera- 
tion or dropsy of the Fallopian tubes, followed as a mat- 
ter of course by menstrual irregularities and sterility. 
Chronic Pelvic Peritonitis accompanies generally tuber- 
culous or uterine disease; becomes sometimes aggravat- 
ed at the periods of ovulation; or may recur after long- 
intervals of absence, from the most trivial cause, appear- 
ing and disappearing often for years. Treatment of the 
acute form as indicated in general peritonitis, Morphia un- 
til perfect ease be obtained; and the bladder ought to be 
emptied by the catheter (p. 125). In the 2d stage, where 
lymph has been the chief, perhaps the only, product of 
inflammation, Tinct. Jodi may be painted over the hypo- 
gastrium once a day for a few weeks. In chronic cases, 
tonics are the remedies, especially Ferrum cum Jodo v. 
Bromo (19 & 1T6); and sexual intercourse should be for- 
bidden. If in spite of the sero-purulent collection the 
patient be doing well, it should be left to empty itself 
spontaneously, else it must be evacuated by aspiration. 



342 Perniones. 

after which the sac has co be washed out with a weak 
solution of Phenol or Tinciura Jodi in warm water. 

Perityphlitis. See Typhlitis. 

Perniones (Frostbite, Chilblains). In consequence 
of severe cold a stagnation of blood in the veins is pro- 
duced in the affected part, which assumes at once a dull 
purplish-red color. Soon, however, the blood is expelled 
by the contraction of the tissues, and the part becomes 
pale, motionless and insensible. This condition is called 
a frostbite, and the best remedy is rubbing the frost- 
bitten part with snow, which after a time may be re- 
placed by cold water (see page 3). Chilblains show, 
like burns, three degrees: 1st, redness and swelling with 
itching; 2d, vesication, the skin around being bluish or 
purple; 3d, ulceration or sloughing — gangrene will re- 
sult if cold be applied continuously. The treatment of 
chilblains of the first and second degree consists in 
friction with snow, cold water and stimulating liniments, 
Terebinthina, Phenol or Acid, nitric. (406 & 409), Mercury, 
Copaiva (404 & 405), etc. For ulcerating frostbites, Que- 
bracho (see Combustio, page 194). 

Pertussis — Hooping or Whooping Cough is an infec- 
tious disease, incident chiefly to childhood, and char- 
acterized by a paroxysmal cough, preceded for some 
days by a common cold, with more or less fever. The 
fits of coughing occur in numerous, short, rapid and 
spasmodic movements, followed by a prolonged sonor- 
ous-sounding inspiration, and expectoration of mucus, or 
occasional vomiting. The treatment has to be directed 
mainly to the neuropathic element: Brom and Belladonna 
(43, 46, 51, 130 & 312); Coccionella, Hyoscyamus, or Alum 
(62, 13 & 132); Acid, nitr., or Picrin (89 & 94); Phenol 



Pharyngitis. 3 43 

or Cocaine (302 & 318) as inhalation, etc. Cerium (p. 29) 
is frequently of service; and fumigations of Sulfur (417) 
are said to be specific. 

Phagedena is a severe ulceration, in which copious 
exudation and infiltration go hand in hand with rapid 
decomposition. It is accompanied either by acute in- 
flammation and fever, the margin of the sore being 
highly painful, swelled and red; or by atony and debili- 
ty, the margin being pale, flabby and livid. Generally, 
it is due to a constitutional disease; and if affecting the 
mouth or genitals of children, it is called cancrum oris 
; noma, and if sloughing, it is known as hospital gan- 
grene. Treatment embraces soothing and antiseptic ap- 
plications with proper attention to the constitutional 
disease. See Gangrene. 

Pharynx — For removal of foreign bodies in the throat, 
see CEsophagus. 

Pharyngitis acuta is an inflammation of the mucous 
membrane of the fauces extending upward — sometimes 
reaching the posterior nares — , and more or less down- 
ward. If low down, and the larynx not affected, there 
is painful deglutition; and a disposition for continued 
acts of swallowing, in conjunction with a peculiar cough, 
which, produced by a forcible current of expired air be- 
ing brought to bear on the pharynx, has a remarkably 
deep and rough sound — the so-called throat cough. 
Sometimes the inflammation involves the tonsils and 
Eustachian tubes, causing more or less deafness, (throat 
deafness). Treatment — Aside from aperients (p. 88); 
fomentations, cold compressds or Acid. acet. (294 & 298) 
to throat; and as gargles, Nitre or Capsicum (300 & 301). 
At the same time Aconite, Antimony or Kali chloricum 



344 Pharyngitis. 

(pp. 23 & 55) as required. The chronic form (Catarrh 
par excellence) is very obstinate, and presents frequent- 
ly p, granulated appearance at the posterior wall of the 
pharynx — granular or follicular pharyngitis. As long 
as the inflammation is limited to the fauces, there are no 
particular symptoms; but generally the larynx will be- 
come slightly affected, so as to give rise to a dry hack- 
ing cough, and a little hoarseness, especially after much 
talking; hence it has been called the "Clergyman's sore 
throat." The Treatment consists in tonics (p. 70); Iodine 
(14 & 18); and topical applications: Argenti Nitras (288 
& 309); Potasii Chforas, or Tannin (299, 300 & 303); 
Ammonii Chloridum, Ferri Chforas, Brom, Jodum (306, 313, 
320 & 321), etc. 

Retropharyngeal Abscess — An inflammation of the are- 
olar tissue between the mucous membrane of the pharynx 
and the vertebral column, culminating in suppuration, 
and characterized by severe pain, especially during 
deglutition. It is generally a consequence of caries of 
the cervical vertebrae. The bistoury. Sometimes the ab- 
scess may be opened with the nail of the finger. 

Phimosis. See Penis. 

Phlebitis — Inflammation of a vein is characterized by 
a red, hard, and cord -like line, tender to the touch, and oc- 
casionally accompanied by sick headache and feverish- 
ness. The idiopathic form is frequently a consequence of 
varicose veins, and is in that case most marked in the 
superficial veins of the leg or thigh, the saphena and her 
tributaries. Treatment consists aside from rest, in fo- 
mentations and purgatives, followed by acid tonics. Iron 
and Quinine (pp. 71 & 76): or Iodine (p. 14); and blisters 
along the course of the vein (408). The traumatic form 






Pica. 345 

requires, moreover, poultices, early incision of abscesses; 
Opium (p. 35), to relieve pain, and a generous diet. Rest 
after a wound, so as not to disturb the coagula, is just as 
important as are proper local applications, to prevent 
access of air, and produce firm coagulation. See note 
on page 139. 

Phlegmasia alba dolexs — Milk-leg or swelled leg 
consists essentially in inflammation of the crural or iliac 
veins, occurring especially in women after delivery, and 
dependent on their reception of poisonous fluid, having 
its source in the fetid discharges of the uterus, which 
infect the open veins of the organ. It is characterized 
by a most excruciating pain along the thigh, leg and foot, 
accompanied by a white, shiny swelling, tenderness on 
pressure, and enlarged lymphatics. Milk and lochia us- 
ually diminish, and in severe cases there will be suppu- 
ration. Treatment — Turpentine stupes or leeches; Opium 
(p. 35), if much pain, and a purgative (p. 88) if required. 
See Septicaemia. After the acute stage, diuretics (p. 40) 
with stimulating frictions (409), and bandaging the limb 
from the toes upward. All lowering measures are 
hurtful. See Puerperal Fever. 

Phlegmon. See Abscess. 

Piiospiiuria. See Urinary Deposits. 

Photophobia. See Eve. 

Phthisis Pulmoxum. See Lungs; Laryngeal Phthisis 
— Larynx. 

Physometba. See Uterus. 

Pica {Longings) — A perversion of appetite, consist- 
ing in a craving for innutritions substances, as chalk, 
charcoal, etc., peculiar to pregnant and hysterical wom- 
en. See Malacia. 



346 Placenta. 

Piles. See Haemorrhoids. 

Pimples (Acne) and Pityriasis. See Skin. 

Placenta previa is called the attachment of the 
placenta to the uterine wall just over the os, so that it 
may be felt overlying the latter like a spongy mass, and 
occasioning already weeks before the term flooding on 
account of the dilatation of the cervical canal. (See 
Hemorrhage). If bleeeding persist, premature labor 
must be induced. When after 10 or 12 hours the os is suf- 
ficiently dilated by a tampon, detach the placenta as 
far as necessary; get hold of the child's feet, and de- 
liver as soon as possible, taking care to immediately af- 
terwards remove the placenta altogether; and make the 
uterus contract. Or, puncture after the removal of the 
tampon the membrane through the placenta with a male 
catheter, and slowly draw off the Liquor Amnii. The 
head will now come down and may act like a compress 
on the bleeding vessels. If not, introduce the finger 
and detach the placenta all around the os as far as you 
can get. If flooding still continue, a warm styptic solu- 
tion of iron should be injected between the detached 
portion of the placenta and the uterine surface by means 
of a flexible gum catheter attached to a syringe. 

Pleuritis- — Pleurisy is an inflammation of the pleura, 
characterized, like pneumonia, by three stages. It is 
generally ushered in by a chill and a sharp pain, of a 
lancinating character in the side of the chest, which in 
deep inspiration cuts the breath, increasing soon to such 
an extent as to make respiration very rapid and super- 
ficial. At the same time there is a dry, short cough, 
dyspnoea and frequently high fever. Auscultation will 
reveal the pathognomic friction murmur. The acute 



Pleuntis. 347 

symptoms subside to a certain degree when effusion 
takes place, producing more or less immobility of that 
side of the chest and disappearance or even bulging of 
the intercostal spaces, whilst the movements of the op- 
posite side are proportionally increased. After absorp- 
tion, as shown by vesicular breathing and vocal reson- 
ance extending to the base of the chest, considerable 
dulness remains for some weeks. Treatment — In the 
first stage, aside from a saline cathartic (p. 96), and 
Opium (p. 35), for relief of pain and cough, sedatives 
— Aconite (p. 22), especially with Nitre (p. bo), are indi- 
cated. Locally, fomentations, Turpentine stupes or cold 
compresses (an ice-bladder is very convenient). Leeches 
or cups are sometimes of service. After effusion has 
taken place, hydragogues and diuretics — Elaterium, Po- 
tassa, Digitalis (205 &. 220 & 123), and Iodine as sorbe- 
facient. A generous diet with restriction in liquids; 
and if necessary, tonics (p. 70), and perhaps alcohol 
(p. 72). Chronic P/euritis, though following sometimes 
the acute form, is generally subacute from the first, and, 
unless like the latter, due to cold or trauma, a sequel or 
concomitant of other diseases. As a rule it is develop- 
ed imperceptibly, pain and other subjective symptoms 
either wanting or but slight; whilst the existence of an 
effusion is well pronounced. There are, however, cases 
in which the presence of liquid can be only demonstrat- 
ed by exploration. A hypodermic syringe with a strong 
needle will answer very well for an exploring puncture, 
and should be resorted to in all cases of pleuritic effus- 
ions to ascertain its character, the more so as it is per- 
fectly harmless. Treatment is the same as indicated in 
acute pleurisy after exudation having taken place; un- 



348 Pleuritis. 

less aspiration be preferred. A small trocar and a ca- 
nula, provided with a stop cock and fitted to a screw 
upon the flexible suction-tube of Davidson's syringe 
may be used for the withdrawal of the liquid, care be- 
ing taken that it is done very slowly, and suspended al- 
together if it give rise to cough or dyspnrea. In Cir- 
cumscribed Pleurisy, which is usually secondary to some 
pulmonary affection, as phthisis or pneumonitis, and 
differing from general pleuritis in not giving rise to 
effusion, medication is rarely required. Em pi. Bell. (411) 
applied to the painful part is generally useful. 

Suppurative Pleuritis, Empyema or Pyothorax is a 
variety of both acute and chronic pleuritis, with essen- 
tially the same symptoms, the only difference being 
that the effused liquid, instead of being sero-fibrinous, 
is composed of pus — hence the more serious character 
of the disease. It may be suspected, if in spite of hydra- 
gogues and diuretics, the effusion continues to increase; 
on the other hand, the appearance of a fluctuating tumor 
is diagnostic in as much spontaneous perforation of the 
walls of the chest is sure to occur sooner or later, unless 
perforation of the lung takes place, (when the pus, 
finding its way into the air passages will be expectorat- 
ed, constituting, on account of the access of air into the 
pleural cavity , pneamo-thorax) . Treatment— Aspiration 
as in chronic pleuritis, especially if the lung has been 
perforated. If, however, this operation repeatedly per- 
formed should not suffice, thoracentesis must be resorted 
to. This has to be done at the bottom of the pleural 
sac, so that the pus may escape freely, and the orifice 
should be kept open by the introduction of an oakum 
tent. The cavity should be, moreover, daily cleaned 



Pleurodynia. 349 

with Aqua phenylata, (1 %) injected by means of David- 
son's syringe, to which has been fitted a double-tubed 
catheter. Half a drachm or one drachm of a solution 
of Naphihol in alcohol and water, in the proportion of 
3: 16 + 32, as intra-pleural injection, is said to have 
proved very efficient, if employed twice a day. 

Pleuritis with Pneumothorax (Pneumohydro-, Pneumo- 
pyo-, or Pneumo-hcemathorax) denoting the presence of 
air and liquid in the pleural cavity, may develop quite im- 
perceptibly and remain even latent; generally, however, 
perforation of the lung is characterized by acute pain, 
severe dyspnoea with accelerated respiration and more 
or less lividity of the face. Pathognomic of the pres- 
ence of air and liquid are the amphoric breathing and 
voice icith a tinkling and splashing sound upon succuss- 
ion. Aside from being due to trauma, or a consequence 
of suppurative pleuritis (see same), it occurs in connec- 
tion with phthisis — occasionally it is produced in certain 
cases of circumscribed pulmonary gangrene. Treatment: 
Opium (p. 35), soothing applications to the chest, and 
ethereal preparations (410 &411), are indicated as palli- 
atives. The chest may be punctured to relieve the 
dyspnoea arising from dilatation of the affected side. 
Aside from this, tonics (p. 69), with a generous diet and 
alcohol (p. h 2). 

Pleurodynia — A rheumatic affection of the muscles 
of the chest, which is, however, to be discriminated 
from intercostal neuralgia. Both are characterized by 
pain, cough and other symptoms pertaining to pleuritis 
or pneumonitis, but they want the physical signs of those 
diseases. Moreover the rheumatic pain is, as a rule, 
more marked in movements of the body than in the 



350 Pneumothorax. 

respiratory movements. Treatment as indicated in my- 
algia — fomentations or Empl. Bell. (411), are sometimes 
of use; and if from uterine irritation Cimicifuga (p„ 47) 
may do some good. 

Pneumonitis. See Lung. 

Pneumorrhagia. See Hemorrhage from the lungs. 

Pneumothorax — Presence of air in the pleural cavity, 
without pleuritis (see same), is generally connected with 
emphysema, and characterized by obliteration of the 
intercostal spaces and amphoric respiration, attended 
with deficiency of breath on exercise, and an occasional 
sharp pain in some part of the chest. Treatment — As the 
perforation will heal up without particular medication, a 
puncture of the chest is not advisable. Soothing appli- 
cations (410 & 411) are sometimes beneficial. 

Poisoning. See Table of Poisons, (p. 3). Poisoned 
Wounds — Wounds. 

Poliomyelitis. See Paralysis (spinal). 

Pollutiones Nocturnal. See Impotenz. 

Polydipsia signifies an excessive craving for liquids. 
Polyphagia {bulimia) a craving for food. 

Polyuria — Hydruria is called a morbid excess of 
water in the urine, and increase of the latter. A symp- 
tom occurring in various cerebral and renal diseases. 
See Diabetes. 

Polypus signifies any sort of pedunculated tumor, be 
it of a warty or epithelial, cystic, hydatid or mucous 
character. Occasionally they are composed of granula- 
tions, as the common aural polypus. The most frequent 
is the mucous polypus, which is very vascular; and the 
common gelatinous variety, which is of the consistence of 
a jelly, slightly streaked with blood vessels and attached 






Pregnancy. 351 

by a narrow neck to the mucous membrane. Fibrinous 
clots attached to the interior of the heart are sometimes 
called polypi. For their treatment see the various organs 
where they are developed — Uterus, Nose, etc. 

Porrigo. See Head, (Tinea favus, capitis, and ton- 
surans). 

Pregnancy — Being in the family way is called in a 
woman the time of gravidity: from the time of concep- 
tion (reckoned usually as the cessation of the catamenial 
flow) until the time when the expulsion of the contents 
of the gravid uterus takes place. It is characterized in 
the course of the first month by a more or less elevated 
temperature of the vagina, sponginess of the cervical 
portion of the uterus, the transverse opening of the os 
changing into a more circular form, and occasionally an 
umbilical pain. Moreover the womb is descending for 
the first six weeks of gestation. After two months the 
mammae will become somewhat sensitive, the areola 
around the nipple becoming puffy and of a darker hue; 
and four weeks later the womb will be found already as 
a hard tumor slightly above the os jy^ois in front, and its 
rhythmic contraction may be felt at intervals of from 
5 — 10 min. by placing the hand lightly over it. When 
the term is half expired (4^ months), the first move- 
ment of the foetus will be felt by the mother: The 
time of quickening. Now the question of gestation can 
be settled affirmatively by the bruit placentaire, the 
pulsations of the foetal heart, and the passive movement 
— ballottement. Aside from any disease which may 
occur during the time of pregnancy, there are certain 
affections peculiar to this state, as vomiting or morning 
sickness, dysuria, oedema, etc., etc. Treatment of dys- 



352 Pregnancy. 

uria: If owing to displacement of the uterus, as ante- 
or retroversion, the position must be corrected. If due 
to pressure of the gravid uterus upon the neck of the 
bladder, the catheter (p. 125). If from any other cause 
Strychnine or Camphora (pp. 27 & 83) see Bladder. In 
oedema associated with albuminuria, Calomel (210); after- 
wards Quinine (166). See Anasarca. If diarrhoea be due 
to a peculiar condition of the ganglionic system, calming 
enemata (381). Vaginitis, even granular, should be 
treated only by frequent injections of warm water (358), 
especially in nervous women. See Leucorrhoea. For 
the treatment of morning sickness, constipation and 
diarrhoea, see Vomiting, etc. 

Pregnancy. Extra-uterine — Ectopic gestation, if it 
can be positively diagnosed, maybe successfully treated 
by the Faradic current (p. 150); after rupture, laparoto- 
my will be indicated. 

Premature Labor. See Labor. 

Priapismus— More or less permanent erection and 
rigidity of the penis without concupiscence, in contradis- 
tinction of satyriasis and due to irritation of some kind. 
It is an occasional symptom of leucocythaemia, myelitis, 
peritonitis and some other diseases. 

Procidentia uteri. See Uterus. 

Proctitis and Paraproctitis — Inflammation of the 
rectum and surrounding connective tissue, which may 
simulate dysentery, as regards the presence of mucus 
and blood in the dejections, together with tenesmus, is 
either due to piles, fecal impaction etc., or a consequence 
of some inflammatory process in the adjacent parts. 
On introducing the finger into the rectum, a hard, painful 
tumor may be felt, which may suppurate and ultimately 






Prostate. 353 

produce a fi&tula. The treatment consists in the re- 
moval of the cause. 

Profuse Menstruation (Menorrhagia). See Hemor- 
rhage from the Uterus. 

Prolapsus Ani. See Anus; Prolaps. Vesicce — Blad- 
der; Prolaps. Urethral — Urethra; ProlajJS. Vaginae and 
Uteri — Vagina and Uterus. 

Prosopalgia. See Neuralgia (trifacial). 

Prostate — Acute Prostatitis is generally a conse- 
quence of gonorrhoea; but it may be due to stricture, 
calculus and other sources of irritation. It is character- 
ized by a throbbing pain about the neck of the bladder, 
tenderness and swelling of the gland on examination 
per rectum, in conjunction with painful and frequent 
micturition. In case of suppuration, the gland will pre- 
sent a tense, fluctuating tumor, and rigors followed by 
high fever will set in, with violent straining and futile 
efforts to urinate. Treatment embraces rest, fomenta- 
tions — leeches if necessary — with Morphium and Bell, 
suppositories (375); or enemata with Opium (381), and 
the catheter. If an abscess form, this may be open- 
ed from the rectum, with a long narrow-bladed knife, 
cutting only at the point, unless it burst into the urethra. 
Chronic Abscess, which is an occasional consequence of 
tuberculous deposit from scrophula, may be suspected, 
if rigors follow the symptoms of inflammation, and the 
gland be felt as an elastic enlargement, tender to the 
touch. It should at once be punctured through the rec- 
tum, unless it has already opened there or in the urethra. 
At the same time tonics (p. 69) will be advisable. Chron- 
ic Inflammation with enlargement from interstitial de- 
posit may be a sequel of the acute, and should be treat- 



354 Prostate. 

ed according to circumstances, by hot baths; Buchu, Par- 
eira and Cantharis <j)p. 47 & 52) or small doses of Mer- 
cury and Iodine (p. 12). 

Hypertrophy > consisting in an enlargement of the 
muscular structure, and incidentally of the glandular ele- 
ments, is almost peculiar to advanced life, and charac- 
terized by difficulty in making water, sense of weight 
in the perineum and tenesmus as from internal piles, 
with occasional fits of complete retention of urine, 
which may be brought on by cold or excess in venery. 
In proportion as the obstacle increases, the bladder re- 
mains distended, whilst the urine continually dribbles 
away, and chronic cystitis is the consequence, which 
sooner or later is followed by disorganization of the 
kidneys. Aside from the introduction of a catheter at 
regular intervals, in order to get rid of the residual 
urine and the prevention of constipation, the irritation 
of the bladder must be alleviated (see same); whilst 
occasional fits of pain or congestion must be treated by 
leeches and hot baths in conjunction with proper diet. 

Prostration. See Debility. 

Prurigo. See Skin. 

Pruritus Ant, see Anus; Pruritus pudendi — Yulva; 
Pruritus of shin — Skin. 

Pseudo-Leucocyth^emia. See Leucocythaemia. 

Psoriasis. See Skin. 

Pterigium. See Eye. 

Ptosis. See Paralysis of third nerve. 

Ptyalism (Salivation, Sialorrhoea) — An excessive 
secretion of saliva may be due to a variety of causes, 
especially to catarrhal affections of mouth and fauces, 
or of the alimentary canal, even of the organs of gener- 



Puerperal Fever. 355 

ation. Sometimes pregnancy is the cause, and some- 
times influences of a purely psychical nature will give 
rise to it. The most violent form of salivation is gen- 
erally a consequence of the use or abuse of mercury. 
For the treatment see Mouth (Stomatitis ulcerosa). 

Puerperal Fever is an infectious and contagious 
disease, produced, for the most part, by micrococci, 
which result from infection of the uterus and abraded 
vagina in consequence of parturition, and usually com- 
plicating or complicated by inflammatory lesions within 
the pelvis or abdomen, thus constituting the many varie- 
ties of this affection. The lesions referred to as gener- 
ally co-existent with the blood-poisoning, manifest them- 
selves primarily as vaginitis, metritis, pelvic peritonitis 
and cellulitis, phlebitis and lymphangitis; and of second- 
ary origin, may be mentioned in addition to pleuritis 
and meningitis, purulent inflammation of the joints, 
pyaemia and circumscribed inflammation of the subcu- 
tanous areolar tissue. The ^fever makes its appear- 
ance in, from two to nine days, following confinement; 
and pursues frequently a favorable course, terminating 
after several days; but even under most discouraging 
circumstances hope of recovery should not be abandon- 
ed, though there are cases, which will prove fatal in less 
than a week. Nevertheless, prevention is better than 
cure, and since we know that infection arises, either 
from wounds or rents in the genital tract, or by absorp- 
tion from surfaces not wounded, but laid bare by the 
process of parturition, we know also, that puerperal fe- 
ver can be very often prevented by the liberal use of 
nail brush, soap and water: Keep hands and instruments 
surgically clean (see note on page 139), whenever you 



356 Puerperal. 

are called to assist a puerpera, and if, in a suspicious 
case, you properly guard against direct infection, puer- 
peral fever will be next to an impossibility, with the 
exception of those extremely rare cases, where it can 
be traced to colonies of bacteria, which, in the shape of 
purulent deposits (the result of old inflammations) will 
probably be present somewhere in the pelvic tissue 
or Fallopian tubes. 

From what has been said it is evident that the symp- 
toms will vary as much in character as in degree of 
severity. Barring fever and pain, there will be consid- 
erable sensitiveness on pressure over the womb, with 
partial suppression of lochia, if Metritis develop. If M. 
suppurativa ensues, the fever increases, chills are more 
frequent, and a fetid diarrhoea is generally the precursor 
of death; whilst simple inflammation of the womb may 
in, from 5 — 8 weeks end in recovery. M. gangrenosa, 
where vagina and vulva become involved, runs also usu- 
ally a fatal course. In Peritonitis, there will be tympa- 
nites, vomiting and coliky pains in conjunction with co- 
pious perspiration; the face will grow dark and flushed, 
and the temperature often reach 105°. Marked consti- 
pation is sometimes present, which may be followed by 
a critical or colliquative diarrhoea. In Putrid Infection, 
which is supposed to be an auto-genetic lesion, due to 
retention of any material in the sexual organs, which 
may have decomposed, there is in addition to repeated 
chills, fever and high temperature, a fetid and per- 
sistent diarrhoea frequently in conjunction with a foul 
discharge from the uterus, terminating as a rule in death. 
Pycemia, which appears seldom before the eighth day 
after confinement (very often much later) and which is 



Fever. % 357 

identical with the surgical lesion, begins invariably with 
an intense chill, the pulse rising rapidly to 130 and the 
temperature to 106° or 107% followed by profuse sweat- 
ing, localized inflammation and abscesses. As purulent 
collections may occur in any part of the body, in the 
liver and spleen (pyaemic abscesses in the lungs and kid- 
neys result frequently from emboli, formed by disinte- 
gration of an infected venous thrombus), or in any of the 
synovial membranes of the joints, a fatal termination 
is also here the rule. Phlegmasia dolens, which appears 
generally during the second or third week after labor, oc- 
curring mostly in the leg, is characterized by great swell- 
ing, the veins being felt sometimes like hard, knotted 
cords; and a shining whiteness of the skin coupled with 
pain and great tenderness. The exudation may be ab- 
sorbed in five or six weeks; however sometimes suppura- 
tive phlebitis will develop, abscesses form, and occasion- 
ally a thrombus, having undergone purulent softening, 
will give rise to infected emboli, which may, in turn, orig- 
inate metastatic abscesses in different parts of the body. 
Treatment — When after parturition, fever, chill, foul 
lochia, and other symptoms of sepsis make their appear- 
ance, the uterus should be searched at once for any se- 
condines, even if lesions exist, to account for them; and 
it should like the vagina, be thoroughly washed with 
phenol, mangan or sublimate water (334, 368 & 397). 
Poultices and fomentations (337) may be required; or 
Zinc, chlor. (340) and an occlusion pad (371). At the 
same time according to circumstances Aconite with Sa- 
licin (p. 22); Quinine and Opium (pp. 11 & 35); and above 
all stimulants (p. 72). As alcohol, in puerperal fever, 
is not only well tolerated, but reduces also the temper- 



358 • Puerperal Fever. 

ature, some practitioners rely, after the appearance of 
constitutional symptoms, solely upon its employment in 
conjunction with lukewarm baths. Brandy or cognac 
may be given with the yolk of an egg in doses of 1 to 
2 teaspoonfuls every hour. The baths are indicated 
by failure of nutrition, incipient somnolence, delirium 
and cardiac weakness (small and quick pulse). One or 
two baths a day, with or without cold affusions, and last- 
ing for 5 to 10 minutes are sufficient. Contraindica- 
tions are collapse, fresh metastases, and venous (femor- 
al) thromboses. Milk, eggs, broth and meat in small 
quantities ought to constitute the sole diet. Obstipation, 
even if peritonitis should set in, is to be relieved by 01. 
Ricini ; violent abdominal pains require the ice -bag and 
opiates; and to allay nausea ice per os or sinapisms to 
epigastrium. See the heads of the complicating diseases. 

Pulmonary Disease. See Lungs; Pulmonary Hemor- 
rhage — Hemorrhage. 

Pulse, if quick and strong, indicates fever, inflamma 
tion,etc; if quick and weak — depression; quick, small and 
thready — great prostration, especially from loss of blood; 
variable in rapidity and force — nervous irritation; jerk- 
ing — valvular lesions; double — continued fevers; inter- 
mittent—obstructed circulation; irregular — disturbances 
of circulation and respiration, or functions of the brain, 
puerperal diseases, etc. The pulse of infants is best 
to be ascertained, when the child is sleeping, though 
there can be much more learned from the expression 
of the face, breathing, heart-beat, etc. See Tem- 
perature. 

Purpura simplex {Purples) — This cutaneous disease 
is characterized by small spots on the skin from minute 



Pyaemia. 359 

extravasations of blood, and attended mostly by lan- 
guor and debility with general malaise. If accompan- 
ied by hemorrhage, especially from mucous surfaces, it 
is called P. hcemorrhagica or Morbus moculosus Werl- 
hojii. The treatment of the idiopathic form is similar 
to that of scurvy, and consists aside from an appropri- 
ate diet,of hcemostatics and tonics: Chininum cum Ferro 
(p. 76); Acidum sulfur/cum v. gallicum (p. 61); Terebin- 
thina (p. 67) etc. 

Pyjemia — A condition of blood-poisoning, which in- 
duces fever, accompanied either by severe gastroente- 
ritis and visceral congestions, or by certain local lesions, 
which are chiefly venous thrombosis, embolic abscesses 
in the viscera, acute suppurations of the serous mem- 
branes and joints, multiple abscesses in the connective 
tissue, and cutaneous eruptions. The fever, ushered in 
by shiverings,is characterized by a very high temperature 
— it may exceed 107.5° — accompanied by offensive per- 
spiration in conjunction with the usual symptoms of 
septicaemia. Suppuration is profuse and may take the 
shape of carbuncles, pustules or erysipelas. The first 
onset of pyaemia may be difficult to distinguish from 
severe ague; and sometimes the joint inflammation 
causes it to be mistaken for acute rheumatism. The 
predisposing causes are those, that produce a low state 
of constitution, and render the blood incapable of form- 
ing a firm clot; such as profuse loss of blood, depriva- 
tion of food, unhealthy air, organic disease of the kid- 
neys and other viscera; even mental anxiety. The im- 
mediate cause may, aside from infection and contagion, 
be disturbance of the coagulum in a vein; as by exer- 
cise of an arm after venesection, or imprudent move- 



360 Pycemia. 

ments after parturition; the presence of septic fluids 
near orifices of veins, unhealthy suppuration in the 
neighborhood of the urethra, or of the mastoid cells. 
However, it may follow mere bruises without wounds, 
exanthemata, cholera or diarrhoea. Treatment— Quinine 
should be given at once, with or without Iron (p. 11). 
If suppuration is established, Acid, sulf.w\t\\ bark (p. 71). 
Alcohol (p. 72) as support. Pyrexia requires the ice-cap 
and sponging (420). Sleep must be procured by Mor- 
phia. Locally leeches and fomentations or poultices if 
much pain and tenderness; and whenever suppuration 
or a puriform deposit takes place, incisions are neces- 
sary, on the same plan as in phlegmonous erysipelas. 
See Septicaemia. 

Pyelitis (Suppurative Nephritis). See Kidney. 

Pyothorax. See Pleuritis suppurativa. 

Pyrosis. See Dyspepsia. 

Quinsy. See Tonsillitis. 

Rabies carina. See Hydrophobia. 

Ranula. See Mouth (TongueV 

Rectum — Foreign bodies in the shape of small bones, 
apple cores, etc., that have passed the alimentary canal, 
or pins and other things, which have been introduced 
into the anus, may be removed by proper forceps, after 
having previously dilated the rectum, by passing into 
the anus several fingers coated with lard, or by means 
of a speculum. 

Ulcers within the rectum, if influenced by the sphinc- 
ter ani are seldom cured without the knife; if however 
out of its reach, soothing enemata (381); Phenol (382); 
Borax (290) and applications of Argentum nitricum (343) 
may be resorted to, after having administered a purga- 






Rectum. 361 

tive (p. 96), which latter may be followed by Acid, nitro- 
mur. (p. 71) and other tonics, to bring the secretions 
into a healthy state. For Piles see Haemorrhoids and 
Hemorrhage. 

Invagination of the rectum, either due to protracted 
constipation or the abuse of warm eneniata, is charac- 
terized by the upper part of the bowel lying within the 
lower, so that the passage on examination with the fin- 
ger is found obstructed by a tumor having in its centre 
the natural opening of the bowel. This state is attend- 
ed with great distress, a constant feeling of weight and 
desire to pass motions without being able to do so. 
Treatment consists in aperients with Nux Vomica (219); 
and astringent injections (378). See Intussusception. 

Stricture — A chronic thickening and contraction of 
the mucous lining, so as to form a ring encroaching on 
the rectal canal is generally situated at from 2 — 4 inches 
from the anus, and unless of a cancerous nature is a 
consequence of contracting ulcers from dysentery, etc. 
If unrelieved it may lead to ulceration of the rectum 
above the stricture with aggravation of all the symp- 
toms, as pain, straining and difficulty in defecation, more 
or less associated with pains in the back and loins, to- 
gether with irritation of bladder, anus and uterus, Treat- 
ment — Aside from aperients (p. 88) and injections to in- 
sure soft stools, a bougie capable of being passed comfort- 
ably through the stricture, should be introduced once in 
three days, and allowed to remain for 15 — 20 minutes. 
The size of the bougie has to be gradually increased. 
Spasmodic Stricture, which is characterized by spasmo- 
dic pains and great difficulty in evacuating the bowels, 
will generally yield to antispasmodics (p. 27) combined 



362 Regurgitation. 

with soothing injections (365 & 381) and a proper diet. 
For Hectocele see Hernia (recto-vaginal); and for other 
rectal affections — Anus. 

Regurgitation is mostly a symptom of indigestion, 
though it very much varies in its character. The liquid 
thrown up by the stomach may be entirely sour if there 
be present an organic acid, as~acetic, butyric, or lactic; it 
may be acrid, appearing to scald the throat; it may be 
insipid, pasty or foul, having the odor and taste of rotten 
eggs, the latter denoting putrefactive changes. If the 
regurgitation occur during the progress of stomach-di- 
gestion, the acidity is usually due to chemical changes 
of the ingesta; but if it occur when the stomach con- 
tains no food, it may come from the gastric glands. For 
the treatment see Dyspepsia (Pyrosis). The acidity of 
the stomach during digestion may be prevented some- 
times by a few drops of Acidum hydrochloratum. 

Relapsing Fever. See Fever (relapsing). 

Renal Diseases. See Kidneys. 

Respiration — The^abdominal form occurs whenever 
there is great pain in using the thorax (pleuritis, etc.); 
or if the brain gets an insufficient supply of blood (croup, 
etc). Cervical respiration predominates when there is 
considerable exertion of the upper ribs, the sterno-cleido 
mastiodeus and other muscles of the neck, as in advanced 
stages of pulmonary and cardiac affections, obstruc 
tion or disease of the larynx, etc. The thoracic form 
again is called into play when there is obstruction to 
the action of the diaphragm, as in abdominal enlarge- 
ments, by dropsy, etc., etc. Stertorous breathing, oc- 
curring in cerebral oppression, depends on relaxation of 
the velum palati; whilst the so-called Cheyne- Stokes re- 



Rhachitis. 363 

spiration, which may be observed sometimes in fatty de- 
generation of the heart, is nearly always due to cerebral 
anaemia: It consists of a period of apparently perfect 
absence of breath, succeeded by feeble and short inspi- 
rations, which gradually increase in strength and depth, 
until the respiratory act is carried to the highest pitch 
of which it seems capable, when the respirations, pursu- 
ing a descending scale, regularly diminish until the com- 
mencement of another apnceal period. Respiration 
proves a valuable remembrancer when using large doses 
of Opium (p. 36). 

Yawning and Sighing immoderately is frequently hys- 
terical; after an attack of hemiplegia, they are unfavor- 
able signs. 

Retention of Menses. See Amenorrhoea. 

Retention of Urine (see Ischuria) may arise from 
causes functional or organic: Want of power of the 
muscular coat of the bladder, diseases of the prostate, 
calculi or foreign bodies blocking up the urethra, pres- 
sure from without, spasmodic or permanent stricture, 
hysteria, etc. For treatment see Bladder. 

Retroflexion and Retroversion. See Uterus. 

RiiACiiiTis is a constitutional disease of early child- 
hood, frequently connected with scrophula, and arising 
from hereditary taint, or from improper food, or by be- 
ing too long and exclusively confined to breast-milk 
(phosphate of lime should be mixed daily into the food 
of pregnant women and nurses). Rickets are character- 
ized by an imperfect development, atrophy and distor- 
tion of the bones, becoming very manifest in the bend- 
ing of the shafts of the long bones and a thickening of 
their articular extremities, a narrow prominent chest 



364 Rheumatism. 

(pigeon-breasted), and a variously curved spine. The 
treatment is similar to that of scrophula: Aside from 
animal food, cold sponging and fresh air, Calcii v. Sodii 
Phosphas (125 & 222); Potassa (31 <fe 117); Iodine (17). 

Rheumatismus articulosus acutus is an essential 
fever, self-limited, and due to a morbid state of the sys- 
tem, involving a rheumatic diathesis. It is, aside from 
occasional complications with bronchitis, pleurisy and 
pneumonitis, often connected with heart disease, and 
characterized by inflammation of the joints, several of 
which may be aff ected at the same time, or singly in ir- 
regular succession. Excruciating pain, more or less 
pyrexia, and profuse, sour-smelling perspiration are usu- 
ally accompaniments; and the blood is highly fibrinous, 
whilst the urine is loaded with uric acid. Treatment — 
Salicin (pp. 17 & 18), given alternately with alkalies, will 
in most cases cut short the disease. If fever high Qui- 
nine (p. 11); Aconite with Salicin or Nitre (pp. 22 &55); 
or sponging, resp. the wet pack (420). For the relief of 
pain Chloral or Brom (pp. 26 & 30); Phenol or Coniin hypo- 
dermically (pp. 107 & 9). The affected joints should be 
wrapped up at once in cotton. Other remedies in use 
are: Nitre (p- 57); Sod. phosph. (p. 58); Lithium (p. 50); 
Digitalis (p. 51). In subacute and chronic rheumatism 
the list of remedial agents may be still further enlarged: 
Silicium (p. 19); Guagac or Iodine (11 & 16); Colchicum 
or Cimicifuga (104 & 5); Xantoxylon (43); and locally, 
stimulating embrocations, Iodine (20); Ammonia, etc. 
(409). Cascara gtt. 15 ter die has been successfully 
used. For Muscular Rheumatism see Myalgia; for 
Rheumatoid Arthritis — Arthritis. 

Rhinitis. See Nose. 



Sarcina. 365 

Rickets. See Rhachitis. 

Ringworm (Dermatomycosis tonsurans). See Head 
(Tinea tonsuraus). 

Roseola — Rose Bash or False Measles consist in ir- 
regular, rose-colored spots on the skin, which do not 
itch, and the redness of which disappears on pressure. 
It is frequently seen in children during dentition, but 
perhaps as often in cases of typhus, syphilis, and oth- 
er diseases, especially of catarrhal affections. No treat- 
ment required. 

Rubeola (Roztheln of the Germans) — An eruptive fe- 
ver of the mildest form occurring sporadically in chil- 
dren, and characterized by small, round, more or less 
itching spots or papules, which appear first in the face, 
and may be associated with a slight nasal catarrh and 
photophobia; but never with bronchitis catarrhalis, a con- 
stant companion of measles. They are, moreover, easily to 
be distinguished from the latter, by their disappearance 
in one or two days, without leaving any trace. No treat- 
ment required. 

Rupia. See Skin. 

Salivation. (Ptyalism). See Mouth (Stomatitis 
ulcerosa). 

Salpingitis (Inflammation of the Fallopian Tubes). 
See Uterus (Cellulitis). 

Salpingocyesis seu Graviditas tubaria (tubal preg- 
nancy). See Pregnancy (extra-uterine). 

Sarcina ventriculi — A fungus found en masse and 
generally in company with the yeast-fungus in the liquid, 
thrown up from the stomach, constituting a variety of 
vomiting, which occurs in certain cases of dyspepsia, 
and which originates probably in consequence of undue 



366 Satyriasis. 

retention of the contents within the stomach from py- 
loric obstruction or some other cause. Sarcinse are dis- 
tinguished microscopically by their oblong or square 
form, and by their being divided by lines into four 
equal squares, so that they resemble a package, tied 
with a cord, as the name sarcina denotes. The vomited 
matter containing sarcina emits an odor of fermenting 
ivort, and is covered after a few hours standing with a 
mass of yeast-like froth. Sulfites (33) are said to 
destroy the fungus. Regulation of diet is, however, 
all important, especially in dyspeptics; hence the bene- 
fit, frequently derived from the hygienic discipline, which 
the hydropathic system enforces upon such patients. 

Satyriasis is a morbid and excessive sexual desire 
in males. It is occasionally a symptom in hydrophobia. 
Brom or Camphora (pp. 24-28), is usually employed. 
Salicin (p. 18), is said to be sometimes of service. 

Scabies. See Skin. 

Scald head (Tinea favus). See Head. 

Scalds. See Combustio. 

Scapulodynia. See Myalgia. 

Scarlatina — Scarlet fever is an eruptive fever of a 
highly contagious nature, and as a rule much more seri- 
ous than measles. It is like the latter disease character- 
ized by an efflorescence, preceded in children sometimes 
by an eclamptic fit; but generally by a sudden attack of 
vomiting, high fever and redness of fauces, in which 
situation the eruption appears prior to the invasion of 
the skin. The cutaneous eruption, which usually begins 
after about 24 hours, affects generally first the chest and 
upper extremities , and is of a scarlet color, so that in 
Borne cases the surface of the body appears not unlike 



Scarlatina. 367 

a boiled lobster. At the same time the throat is more 
or less affected, and some swelling of the tonsils is, like 
the pathognomic strawberry-tongue^one of the early symp- 
toms. The rash may stand for, from 4 to 10 days, be- 
fore desquamation begins, which either consists of 
simple exfoliation of the cuticle, and takes the form of 
minute branny scales, or of shreds of the epidermis 
in large pieces. A frequent sequel of this disease is 
renal disorder with dropsy. In Scarlatina anginosa, 
the affection of the throat may be so severe, as to en- 
danger life; whilst the hemorrhagic form is almost in- 
variably fatal. Treatment — According to the severity 
of the fever, Aconite (pp. 22 & 55); Veratrum (p. 39); 
or Quinine (p. li); with or without sponging, the wet 
sheet or pack (420). Acid, hydrochloratum and Potassii 
Chloras (pp. 42, 55 & 56), will usually suffice in mild 
cases. Some physicians prefer Salicin or Thymol (pp. 
18 & 19); the temperature is said to fall rapidly after 
the use of acid, salicyl. (26). Baptisia & Mercury (pp. 
10 & 13) have been sometimes of service. Locally 
cold compresses and gargles with Phenol, Tannin, etc. (298- 
300). An emetic (227) if the throat much stuffed; and 
if there be determination to the head, enemata (386). 
If restlessness, Brom or Hyoscyamus (pp. 33 & 55). 
Belladonna (43) is frequently used as preventive. In 
uraemia, saline purgatives or Elaterium (pp. 91 & 96). 
As support, brandy (p. 72) in form of milk punch, etc., 
with a nutritious diet. 

Scarlatina rheianatica — Dengue is an epidemic, self- 
limited affection, with a short prodromic stage — an- 
orexia, languor and general malaise — characterized 
by a paroxysm of fever, which may last from a few 



368 Scorbutus. 

hours to several days, in conjunction with rheumatic 
pains, and followed generally by an eruption, either 
papular or vesicular. Coryza, pharyngitis, and enlarge- 
ment of cervical glands are occasional complications; 
and hemorrhage from the nose, mouth, bowels or uterus 
may occur. Diagnostic are the severe pains all over the 
body, in head, eyes, muscles of neck, loins and extremi- 
ties; hence the significant appellation, breakbone fever. 
Treatment — Aconite with Salicin (p. 22); and sedatives, 
Belladonna or 0/?/t//w(pp. 24 &35). Brandy will sometimes 
do good. If constipation, Iodine with Colchicum (p. 48). 

Sciatica. See Neuralgia. 

Sclerosis. Cerebro-spinal, See Brain. 

Scorbutus — Scurvy is a morbid state of the system, 
due to want or insufficiency of certain principles in food 
necessary for nutrition, and characterized by debility, 
associated with mental and physical depression and 
general malaise. Diagnostic is sponginess of the gums, 
fetor oris, and extravasation of blood beneath the skin. 
Sometimes there is hemorrhage from mucous surfaces, 
as from the nose and bowels. Treatment embraces 
tonics, especially mineral acids (p. 71); Ferrum (142), 
in conjunction with lemons and other fruit; fresh meat, 
milk and farinaceous food. 

Scrofula — Struma, called alsoiTm^'s Evil, is a mor- 
bid condition of the system, caused, unless hereditary, 
by improper food, in conjunction with unhealthy air dur- 
ing the first years of childhood. It is characterized by 
a tendency to various inflammatory and ulcerative pro- 
cesses, as swellings of the absorbent glands, especially 
those of the neck; persistent swelling and catarrhal in- 
flammation of the nose; swelling and thickening of 



Septicemia. 369 

the upper lip; abscesses; cutaneous eruptions; and caries 
of the bone. Most frequently we meet the chronic 
swelling of the lymphatic glands about the neck, behind 
the ear, under the jaw and in the clavicular region. 
Scrofulous gummata, which begin as small infiltrations 
or nodes in the skin, constitute another form of scrofu- 
loderma. They are of a livid red color involving the 
entire skin, spread more and more to soften at different 
points to small ulcers, with burrowing sinuses, which 
form a sort of communication between them. Another 
variety is characterized by the formation of papillary 
wart-HJce or fungous groicths, of a pale, bright dusky or 
violaceous red color, which soon ulcerate, with a thin 
discharge and some crusting. As a fourth variety of 
scrofuloderma may be mentioned, small, hard and flat 
papules with a raised violaceous areola. Treatment — A 
good nourishing diet in conjunction with Ol.Jecoris (2 3 
& 185), and alkalies (pp. 18 & 53); Iodine or Mercury 
(pp. 13 — 15); and an occasional purgative (pp. 92 & 97), 
constitute the chief remedial measures. Natr. nitric, or 
phosphor, (p. 57) is sometimes indicated. Calomel v. 
Hydrarg. c. Creta (p. 92) twice or thrice a week at bed- 
time, with a saline every morning (p. 95) and mineral 
acids (p. 71) according to circumstances, is also recom- 
mended. In obstinate cases Aurum or Barium (p. 10), 
may be tried. Ungt. Unci locally. See Leucocythaemia 
and Lymphatics. 

Scurvy. See Scorbutus. 

Seasickness. See Morbus nauticus. 

Sebaceous Cyst. See Cyst and Skin (Wen). 

Septicaemia occurs like traumatic or symptomatic fe- 
ver, which accompanies inflammation from injury, and 



370 Septicemia. 

the hectic form, consequent upon prolonged suppuration 
in connection with wounds, operations, etc.; but whilst 
those, depending also on blood-poisoning will disap- 
pear, if the local mischief can be remedied, septicaemia 
will continue, though the prime cause be removed; and 
it may be very severe, though the latter be but insignifi- 
cant. The nature of the poison is not mere putrefac- 
tion; but something that has a perverted vitality; for 
the fluids of a putrid subject are less likely to infect a 
post-mortem operator, than the fluid from a fresh corpse 
of a puerperal fever victim. The diagnosis of Septic- 
aemia and Pyaemia, following wounds or injuries, is 
easy enough; but when there has been no lesion to ac- 
count for it, it may be extremely difficult. It should 
not be mistaken for typhus, cerebro-spinal meningitis, 
acute rheumatism, and inflammation of the kidneys or 
bladder. From typhoid it may be differentiated by the 
fact, that the latter is never complicated with a pustular 
or papular exanthem, with a hemorrhagic basis. In ad- 
dition to a rise of temperature to from 101 — 103°, there 
will be in severer cases of septicaemia profuse vomiting, 
fetid diarrhoea or dysentery; the disease may even take 
the form of erysipelas, phlegmasia dolens or pyaemia, 
and any of these forms may beget any other: Thus, 
the poison of erysipelas may beget puerperal fever — 
this is said of any form to exist, if the patient be a puer- 
pera — and the child of the fevered mother may die of 
erysipelas. Treatment — If the patient after any injury, 
etc., is seized with uneasiness, cold shivering and light- 
headedness, the temp, exceeding 101°, some form of 
septicaemia may be suspected, and an energetic treat- 
ment is imperative: Any pus that may be anywhere 



Skin. 3 71 

retained, must be got rid of. At the same time a good 
stimulant, brandy and water or hot negus (p. 72) and 
Quinine (7). See the various forms. Aconite with Sal- 
icin (p. 22), locally Phenol, Zinc, chlor. etc. (337 & 349). 

Sexual Weakness. See Impotenz. 

Shaking Palsy. See Tremor. 

Singultus — Hiccough is supposed to be caused by a 
chronic spasm of the diaphragm in conjunction with 
partial or complete closure of the glottis, producing 
quick, abrupt and sounding inspirations. Treatment — 
Whilst simple hiccough will wear off without remedial 
aid, or be stopped by a pinch of snuff, drinking water, 
swallowing a piece of ice, or a sudden fright, as caused 
e. g. by an unexpected slap on the back, the application 
of Cocaine or the inhalation of Chloroform will gener- 
ally cure the more obstinate form. If persistent, Chlo- 
ral 3 ss to produce a sound sleep; or Camphora (p. 27). 
Sometimes Morphium or Pilocarpin hypodermically (254 
& 56) will be of service. One drop of a one-per-cent 
solution of /Vitro -glycerine, bihorio, has been employed 
successfully, in a case where all the sedatives in turn 
had been tried in vain. 

Skin diseases — In these are included affections of the 
sebaceous follicles, pigmentations and neoplasms; whilst 
diseases of the head, of the sudorific glands, and those 
where the skin forms only part of the disease, as ro- 
seola, erysipelas, furuncles, lupus, etc. are treated of in 
alphabetic order. Scrofulodermata and syphilitic ex- 
anthemata, which latter are known by the characteris- 
tic copper color, and by the fact that they never itch, 
claim a specific treatment; whilst eruptions, which are 
met with as concomitants of disorders, affecting the 



372 Skin. 

generative organs in the female, require proper atten- 
tion to the disease, with which they maybe in connection. 

A diffuse but slight dermatitis, characterized by uni- 
form redness of the skin, with more or less puffiness, is 
called Erythema, and requires no treatment unless it be 
accompanied by much itching. That form, produced 
by pressure during a protracted illness and eventuating 
in bedsores, may be washed with Arnica or brandy and 
water — see Decubitus. Another form, Intertrigo, oc- 
curring between folds of the skin in infants or fat peo- 
ple (or of any person between the legs from walking), 
may, after having been washed with soap and water, be 
dusted with Camphorated powder, Lycopodium or Zinc 
(339 & 393). Pruritus, which consists of a most vio- 
lent itching and is generally attributed to nervous irri- 
tation, proves sometimes a most obstinate disease, that 
requires, as a rule, internal medication — Alkalies (pp. 53 
& 54); Phenol, Sulfur or tonics (pp. 16, 69 & 98). Locally, 
Borax, Camphora, Iodoform and Cyan (346, 390-94 & 409). 

Prurigo, which has the constant itching in common 
with pruritus, is a papular eruption. The minute papu- 
les neither ulcerate not wet, but if they are scratched or 
pricked with a needle, they exude a serous fluid, which 
dries into scabs. The disease, mostly due to want of 
cleanliness, is sometimes extremely obstinate. A pseudo- 
prurigo is produced by the bite of vermin, as lice, etc. 
Treatment as indicated in pruritus. Lichen, a papular 
eruption, differs from prurigo in that the papules itch 
but little if at all, and in the fact that when pricked, 
blood is exuded. There are two forms, L. Scrofuloso- 
rum and L. ruber-, the latter, which may be distinguished 
from psoriasis, by not forming circles, ie generally associat- 



Pemphigo. 373 

ed with tuberculosis. Treatment — Alkalies (pp. 53 & 
54); Iodine (pp. 14 & ] 5); Cod liver oil (20 & 185); Arse- 
nic (p. 9); Cantharis (p. 47); etc. Naphthol (390) is some- 
times used externally. 

Herpes — Clusters of minute vesicles, often preceded 
by local irritation, especially a sensation of burning, and 
cutaneous neuralgia, and frequently connected with 
acute catarrh of the stomach. Treatment is seldom re- 
quired — Quinine (p. 76) is sometimes employed in H. 
/tibialis, if due to mental excitement. In It. Iris and 
circinnettus, Cuprum (391); Iodoform (401); etc. In H. 
Zoster, Morph. oleic, Argent, nitric. (409); Phenol, Bis- 
muth (3 £8 & 99); etc. In II prceputialis, which occurs 
often in men, who have had chancre, Calomel (353). In 
H. prdgeriitaKs, which appears sometimes on the labia 
of women in the climacteric period, hot fomentations. 
Eczema — Minute vesicles developed on red and slightly 
raised surfaces, drying off in scabs and always combined 
with violent itching. It may be caused by want of 
cleanliness, any kind of local irritation or improper food; 
sometimes it is symptomatic of defective menstruation, 
scrofula and other diseases. Treatment is to be direct- 
ed to the cause — Alteratives, Arsenic (p. 9); Pulsatilla 
(p. 16); etc. Locally, especially in Eczema of the ex- 
tremities (Salzftuss), Tar, Alum or Phenol (397-99) ac- 
cording to the form, whether simplex, rubrum — where 
the skin is more inflamed; or impetiginoides — in case 
of pustules. In Eczema of the genitals, Cocaine, Borax 
or Argentum (285, 390 & 404). In Eczema facialis, 
Mercury, Zinc, Naphthol or Salicin (390, 91 & 99). See 
Head f Crusta laded). 

Pemphigo — Large bullae filled with serum, to be met 



374 Skin. 

with chiefly in infants, suffering from congenital syphi- 
lis. Treatment — In the idiopathic form, P. vulgaris. 
Sulfur (p. 98); dusting with Amylum or Lycopodium and 
an occasional bath. If malignant, P. foliaceus— where 
the bullae unite to raise big patches of the epidermis, and 
which proves generally fatal — Arsenic (p. 9 ) may be tried. 

Pupia — Flattened bullae, filled with serum, which 
gradually become opaque and purulent, and finally dry 
into oyster-shell-like scabs, under which the skin is ul- 
cerated. Treatment is directed to the cachexy, which 
may have given rise to it — syphilis, scrofula, etc. 

Impetigo — Small pustules, slightly elevated and ter- 
minating in a laminated scab, occurring usually on the 
extremities of scrofulous subjects, in conjunction with 
eczema. Treatment — After having removed the scab 
by some kind of grease, Bismuth with Zinc or Tannin 
(340 & 393). 

Ecthyma — Large, prominent or flat pustules, encircled 
by an inflamed margin and leading to ulcers, occurs 
sometimes symptomatically in malarial fevers and other 
acute diseases; but generally it is due to some cachec- 
tic state of the blood. Treatment — Iodine (pp. 14 & 15); 
Oleum Jecoris (20 & 185); Quinine (p. 76); etc. Locally 
warm bathing and dusting with Lycopodium, etc. Black 
or yellow wash (329) after removal of the scab. 

Psoriasis scutellata sen Lepra vulgaris, which, though 
frequently hereditary, is never dependent on a cachec- 
tic state of the blood, if we except the syphilitic form, 
consists of the hypertrophied cuticle being raised, so as 
to produce a rough and scaly appearance of the skin. 
Treatment — Aside from warm baths, and local applica- 
tions, as Creosote or Tar (398 & 99), alkalies (pp. 53 & 



Comedo. Sl5 

54) are usually given. Phenol and Iodine (pp. 14-16) 
may be tried; or Cantharis and Sulfur (pp. 47 & 98). 
Arsenic (p. 9) is said to improve it after a week's use. 

Ichthyosis — Large scales like those of a fish, which 
may cover the larger part of the body. Treatment is 
but palliative, Glycerine or oil with warm bathing. 

Urticaria or Nettle rash consists of an eruption simi- 
lar to that, produced on the skin by nettle, and is gener- 
ally accompanied by fever. In some people it is caus- 
ed by eating oysters, strawberries, copaiva, etc.; how- 
ever often it is connected with depressing mental influ- 
ences, disorders of the digestive system or of the sex- 
ual organs. Treatment according to cause — Alkalies (pp. 
53 & 57), Colchicum (105) in gouty persons, etc. To al- 
lay the itching, Borax or Chloroform (394 & 410). 

Comedones and JHUa consist of inspissated sebum, 
which blocks up the mouth of diseased sebaceous folli- 
cles, and may give rise to the formation of a true re- 
tention cyst or of acne papules. While the comedo 
will appear as a black point anywhere on the face, es- 
pecially on the nose, milia may be seen as white no- 
dules chiefly under the eye or on the palpebrce. Treat- 
ment— The comedo is easily removed by pressing the 
plug out with the fingers or a watch-key; milia are bet- 
ter destroyed by electrolysis, as employed for the re- 
moval of superfluous hair (p. 149); though the contents 
of the white tumors may also be scraped out with the 
curette, after having incised the skin that covers them. 
Eau de Cologne may subsequently be used as a wash to 
keep the orifice patent. Acne pustulosa and indurata, 
which are inflamed sebaceous follicles with or without 
suppuration, require also the dermal curette. Pimples 



376 Shin. 

which make the life of a youth often so burdensome, will 
sometimes be benefited by sulfites, Iodine or Naphthol 
(17, 21 & 33), with Soda (392) locally. Acne rosacea 
(Schnappsnase), which consists in hypertrophy of the 
areolar tissue and skin of the nose, in conjunction 
with enlarged sebaceous follicles, and mottled with di- 
lated veins, requires in its first stage also the curette; 
and if drinking he discontinued Sulfur internally and as 
wash (7:50 Aqua) maybe of service. Sublimate (0.03 : 
100.0), to paint the nose with every night is also 
used in this stage. In the second stage, aside from cu- 
retting acne papules and pustules, the dilated vessels 
must be punctured with a needle or cut with a multiple 
scarifier, after which cold compresses may be applied. 
The procedure should be performed every day or 
every other day, aud only part of the affected area of 
skin should be operated upon at a time. Electrolysis 
(p. 149) is also employed; but the current should be very 
weak, and the needle has to be introduced into the lar- 
ger vessels. In the third stage, where perivascular over- 
growth has taken place, the shrinkage of the new tis- 
sue causing the gradual disappearance of the blood ves- 
sels, and the part enlarging more and more, excision 
is the only remedy. 

EphelidcB s. Lentigo — Freckles are pigmentary depos- 
its on the skin of the size of a lentil seed. Bismuth and 
Borax (392) are frequently used as wash. Chloasma 
uterinum — A mole may be treated in the same way. 
Ncevi pigmentosi may also be removed by electrolysis: 
Acid, chrom. (1:4) and Acid, carbol. (1:2) upon the need- 
les have been employed. ' Parasitic moles (pityriasis 
versicolor sen dermatomycosis microsporina) are due to 



Clavus. 377 

■ 

a fungus, and are easily removed by washing them with 
Aqua phenylata (1%) and soft soap. 

Verruca — Warts and vegetations consist in a hypertro- 
phy of the papillae and cuticle. A variety, Condylomata 
(Feigvoarzenof the Germans), which are clothed with a 
thin cuticle, grow principally on the inside of the thighs, 
perineum, about the anus, and within the prepuce or 
vulva. Highly vascular and easily bleeding; or pale and 
indolent; broad and flat; or tall and stalked — -jicus — , 
they discharge a thin ichor, and are always caused by the 
irritation of gonorrhoeal or syphilitic discharges, com- 
bined with want of cleanliness. Treatment — For the 
removal of ordinary warts, electrolysis (p. 149) may be 
employed as in hypertrichosis. The needle should be 
passed through the base of the growth in various direc- 
tions, and a moderate current allowed to flow for a few 
minutes in each. If an electrical apparatus is not handy, 
they may be snipped off with a knife or curved scissors, 
and then touched with caustic. Solutio Fowler/' applied 
once a day, is said to destroy them within a fortnight. 
Acid, nitric, acetic, and chromic (329 & 403) are also 
used, especially for condylomata. See Syphilis. 

Clavus — Corns are growths of thick cuticle, not mere- 
ly lying upon the true skin, like callosities, but penetrat- 
ing it. There are two kinds, the hard and the soft 
corn, the former being situated on the surface of the 
foot, where the cuticle can become dry and hard; the 
soft between the toes, where the cuticle is soft and 
spongy. Treatment — Next to proper fitting footwear, a 
pediluvium of at least half an hour's duration every night, 
is perhaps the most effective remedy. Of the many lo- 
cal applications in use, may be mentioned Salicin-Col- 



378 Skin. 

• 

lodion, consisting of acid, salicylic, part 1, morphia p. 2, 
and Extr. Cannabis fluid, p. 12, to 200 parts Collodion. 
This is applied to the corn, previously closely pared, un- 
til a film forms. Callosities (Callus or Tylosis) re- 
quire the bath. 

Wens are encysted tumors, most common on the head, 
face and shoulders, consisting of obstructed sebaceous 
glands or else of erratically-developed cutaneous cysts. 
The matter contained is a collection of epidermic scales 
with hairs, oil-globules and crystals of cholesterine, and 
has received the name of atheroma or steatoma, from its 
resemblance to gruel or suet. Suppuration, ulceration, 
and fungous granulation of the interior of the cyst 
sometimes occur. Treatment — If an aperture is visible 
and the tumor is not very large, it may be opened by a 
probe or director, and the contents be pressed out. How- 
ever, it is better to extirpate it entirely by running a 
scalpel through it, seizing the cut edge of the cyst and 
gently tearing it out with a touch or two from the knife. 
If the wen is much inflamed, it may be laid open by a free 
incision, as much of the cyst as possible got away with 
the contents, and then filled with lint and Ungt. Creosoti 
or 01. carbol. (398), to suppurate and contract. 

Cheloid tumors consist of a hypertrophy of the tis- 
sue of the true skin, intermixed with newly-developed 
fibrous or cicatricial tissue. They are generally devel- 
oped on sites of cicatrices, even on leech bites and on 
ears, that have been pierced for earrings, they may be 
seen. Iodine and Arsenic (pp. 9 & 14) are mostly em- 
ployed and Scarification, as in acne rosacea, is recom- 
mended, since extirpation is of no avail. 

Molluscum epitheliale seu contagiosum is characterized 



Scabies. 379 

by rounded, wart-like papules, varying in size from a 
pin head to that of a pea, and occurring usually in the 
face, especially the eyelids, cheeks and chin. They fre- 
quently look like drops of white wax upon the skin, or 
like a pearl button flattened on top, constricted around 
the base, and with a dark aperture in the center, from 
which can sometimes be squeezed a milky fluid. Eventu- 
ally they terminate by disintegration. Treatment — If ap- 
plications of Ungt. Hyrarg. alb. or Sulfur fail to destroy 
them, the ligature or the cautery may be employed; or 
they may be opened with a knife or scraped away with 
the curette. The bottom of the cavity should afterwards 
be touched with caustic. Molluscum fibrosum seic Fi- 
broma molluscum is a chronic hypertrophic affection of 
the skin, consisting in sessile or pendulous growths of 
cutaneous connective tissue, which may cover the whole 
body. The tumors maybe excised or ligatured. The gal- 
vano-cautery and electrolysis (p. 149) are also employed. 

Scabies — Itch consists in an eruption of pustules and 
vesicles, appearing usually between the fingers and toes, 
about the wrists, at the elbows and knees, accompanied 
by severe itching; especially after getting warm in bed, 
and due to the irritation, which is caused by the bur- 
rowing of a parasite (Acarus scabiei). Treatment — Sto- 
rax, Sulfur, Potassa or Napththol (390) as ointment 
will kill the parasite. To hasten the cure these applica- 
tions may be preceded by rubbing the parts daily with 
soft soap, followed by a warm bath. 

Sleeplessness. See Insomnia. 

Small pox. See Variola. 

Snakebite. See Wounds. 

Soor (Stomatomycosis). See Mouth. 



380 Spasms. 

Sore throat, Clergyman's. See Pharyngitis (chron). 

Spasms — Cramps are painful contractions of muscles, 
irrespective of affections of which they are symptomat- 
ic, as tetanus, etc. Tonic spasm of the sterno-cleido- 
mastoideus constitutes the Caput obstipum. In clonic 
spasms the trapezius is mostly implicated, and if uni- 
lateral, the muscles of the face will help in cutting 
wry faces; — bilateral they are called Salaam spasms 
(Komplimentirkraempfe of the Germans). See Wry- 
neck. Writers cramp (grapho-spasmus — Chorea Scrip- 
torum) requires rest of the hand for a long time; chang- 
ing the size of the pen may be tried; Galvanism (p. 148) 
maybe of service. In cramps of the legs or feet, Lycopo- 
dium (76); Viburnum (p. 39). Sleeping on an inclined 
plane is recommended: the bed being a foot higher at 
the head than at the feet. For Spasmus Glottidis, see 
Larynx; for Spasm. Vagince — Vaginismus; Sp. Vesicae 
— Bladder; Spasms in Infants — Convulsions, etc. 

Spermatorrhea. See Impotenz. 

Spine — Myelitis. Inflammation of the spinal cord, 
if acute, takes generally the form of softening; whilst 
if chronic, it appears as induration or sclerosis. Acute 
myelitis, being characterized by fever, violent pain in 
the back, and complete paraplegia, with loss of power 
over bladder and rectum, is, aside from injuries, gener- 
ally due to cold and wet; though it may also occur dur- 
ing acute rheumatism. Treatment — Leeches or cupping 
with ice-bag to spine; blisters and warm baths; above 
all, absolute rest, the decubitus being as much as possible 
on the abdomen. Internally Ergot and Belladonna (pp. 23 
& 65)with a view of contracting the arteries of the cord. 
Mercurialization (12) is recommended. Strychnoss is 



Spine. 381 

contra-indicated. In the chronic form, where there is 
superadded wasting of the paralyzed muscles and a ten- 
dency to gangrenous ulceration, next to rest and contra- 
irritation (409 & 10) over spine, Belladonna and elec- 
tricity (p. 148). Colch ; cum (p. 48) or alkalies (p. 53,) if 
indicated by the state of the urine. 

Spinal Irritation is a neuropathic affection, charac- 
terized by pain and tenderness over the spine in con- 
nection with some other disorder, and mostly due to an 
anaemic or hysterical condition: If there be intercostal 
and cervico-occipital neuralgia, nervous cough, pal- 
pitation, vomiting and singultus, the cervical or dorsal 
vertebrae will be found upon pressure to be tender; whilst 
tympanites, colic and dysuria are associated with lumbar 
tenderness. Treatment — Aside from proper attention 
to the causative affection, Veratrum or Choloroform (410 
& 11) locally. Anodynes maybe called for — Aconite, 
Belladonna or Brom (pp. 22-27); Cocaine and Iodoform- 
Collodion (pp. 77 & 109). See Neuralgia. 

Spi?7a bifida — Hydrorachitis is a congenital affection, in 
which the vertebras of the lumbar or sacral portion are 
cleft or deficient, so that the spinal membranes yield 
to the pressure of the subarachnoid fluid, which they 
contain, and bulge out, forming a fluctuating tumor of 
variable size in the middle line of the back. Hydro- 
rachitis is generally accompanied by paralysis of the 
bladder, rectum and lower extremities; though in the 
rest the infant may be perfectly well. Gentle pressure 
is all that can be done in the way of treatment. 

Curvature of the Spine may be lateral — from debili- 
ty of the ligaments and muscles of the spinal column; 
angular (Pott's Curvature), produced by softening and 



282 Spine. 

absorption of the intervertebral substance and caries of 
the bodies of the vertebrae, due to scrofula; or directly- 
forward or backward, mostly seated in the upper part of 
the back and always a consequenee of rickets. Pottfs 
Curvature generally begins with a dull pain, especially in 
adults, aggravated by motion. If the disease is situat- 
ed in the dorsal vertebrae, there may be tightness of 
the chest with difficulty of breathing; and if in the cer- 
vical, one or both arms may be palsied, and inability of 
carrying the head without supporting it. Sooner or later 
scrofulous abcesses may form, accompanied by hectic 
and great constitutional derangement. Next to a con- 
stitutional treatment, generous diet and general hygienic 
measures, perfect rest is indispensable, and may to a cer- 
tain degree nearly always be insured by proper mechan- 
ical appliances. If the back be very weak, the patient 
should, when not moving about, neither sit much nor 
stand, but maintain as much as possible a reclining posi- 
tion on a hard surface. In Pott's Curvature, however, 
where the horizontal posture is absolutely necessary, the 
patient must by no means be taught to lie on his back. 
Issues on the sides of the diseased vertebra will do no 
good in scrofulous subjects; but leeches may be applied 
to relieve occasional accessions of pain and tenderness. 

Spleen. Enlargement — Ague Cake occurs in connec- 
tion with acute specific or infectious diseases, and with 
certain chronic affections. Treatment according to the 
associations belonging to it. If due to malaria, Qui- 
nine (p. 11); Salicin (p. 16); ifowing to leucocythaemia, 
Ferrum, Ergot (pp. IS & 79) Brom (p. 25) etc. 

Sprains — A violent stretching of tendon, ligament or 
fascia^ with or without rupture of some of their fibres 






Sterilitas. 383 

and blood-vessels, constitute a sprain. It produces in- 
stant severe pain, often attended with faintness, great 
tumefaction and ecchymosis, and subsequent weakness 
and stiffness. If the part is not kept at rest and the 
knee or some other large joint affected, there will be in- 
flammation and fever that may lead to serious, even fa- 
tal results. Treatment — In slight cases, perfect rest, in 
conjunction with cold water applications and a bandage 
may suffice; but if a large joint, e. g. the knee, be affect- 
ed, the patient should go to bed, and the knee should 
be confined by a splint behind, and held in place by a 
bandage comfortably applied. During the first day or 
two the object is to allay pain, and to anticipate inflam- 
matory effusion by cold affusion or warm fomentations 
and plain diet. If inflammatory pain, i. e. throbbing 
heat and swelling, should be developed, leeches should 
be applied. That the reparative process may not be 
disturbed, the part should now be supported by a a firm 
bandage, once daily douched with cold water and per- 
haps rubbed with a stimulating liniment (409). If af- 
ter a sprain, the injured part is subject to fits of inflam- 
mation, and very slow in recovering its powers, Iodine 
(p. 14) will be indicated as in chronic rheumatism. 

Stammering — The inability of uttering certain words 
or syllables with fluency, unless due to lesions in the 
medulla oblongata or spinal marrow, may be treated 
successfully by gymnastic respiration in conjunction 
with pronunciation, making the patient say "her" before 
each word beginning with a consonant. 

Sterilitas — Barreness is the consequence of a mul- 
titude of causes; it will be caused through impossibility 
of the entrance of the seminal fluid into the uterus, as 



384 Sterilitas. 

is the case in cervical endometritis, etc.; by the preven- 
tion of the production of a healthy ovule (from chronic 
ovaritis, etc.); by preventing the passage of the ovule 
into the uterus (from stricture or obliteration of the 
Fallopian tubes); by destroyed vitality of semen or the 
prevented fixation of the impregnated ovum, a result 
of endometritis; membranous dysmenorrhea, menorrha- 
gia or metrorrhagia, abnormal growths, etc. The most 
frequent causes are glandular cervical endometritis; ar- 
eolar hyperplasia from subinvolution of uterus; leucor- 
rhoea and other morbid discharges, either by causing 
death of the spermatozoa or by changing the lining 
membrane of the uterus; obesity, by impairing the 
function of the ovaries; flexions and versions; and ex- 
cessive sexual intercourse. Treatment — Removal of 
cause if possible. If it is due to a congested state of 
the uterus, or to atonicity, suction at the breast may re- 
move it: in the former case as derivative; in the latter, 
through the reflex action it produces, securing contrac- 
tion of the flaccid uterus. If stricture of cervix, dila- 
tation; if its vaginal portion should be projecting, or 
conical, the bilateral operation for its enlargement, or 
amputation, if necessary. 

Steatoma or Atheroma. See Skin (Wen). 

Stomach — Dilatation or Gastrectasia, mostly due to 
pyloric obstruction produced by cicatrices of old ulcers, 
cancer and similar causes, is characterized by an ab- 
normal prominence of the epigastric region, extend- 
ing more or less over the umbilicus; and a periodic 
vomiting at intervals of a day or two, containing the 
ingesta of the previous day — The amount of dilatation 
may be ascertained by means of soda (p. 55). Treatment 



Stricture. 885 

demands above all regulation of diet: Saccharine and 
amylaceous articles should be avoided on account of 
their tendency to fermentation. Peptonized food (pp. 
84 & 137) is sometimes of service. At the same time 
tonics, especially Strychnos (152). 

Ulcus rotundums. perforans occurs either in the lower 
part of the oesophagus, in the stomach, or in the upper 
part of the intestine; and is generally produced by the 
solvent action of the gastric juice. Gastric ulcers are 
characterized by a gnawing, circumscribed pain coming 
on directly after meals; tenderness on pressure in the 
same place; and vomiting and hemorrhage usually asso- 
ciated with constipation. Treatment — Aside irom pep- 
tonized food (p. 84); or milk as diet (if vomiting has 
ceased), or recta/ alimentation (p. 13l),Sub/imate (p. 13). 
For the relief of pain, Morphinum (pp. 38 & 110); and 
in case of hemorrhage, ice per os and Ergot per anum 
(383). For other stomachal diseases see the several 
heads as Gastritis, Gastralgia, Enteritis, Dyspepsia, 
Hemorrhage (Haematemesis), etc. 

Stomatitis — Stomacace (Stomatitis ulcerosa) — Stom 
atodysodia (Fetor Oris) — Stomatomycosis, etc. See 
Mouth. 

Strangury — Painful micturition, the urine being 
passed only in drops, is a constant symptom in chronic 
cystitis and spasmus vesicce. See Bladder. 

Stone. See Calculi. 

Stricture — Permanent stricture of Male urethra 
arises from repeated gonorrhoea, intemperance, unheal- 
thy condition of the urine, etc. Treatment — A bougie 
or catheter a boule is the best instrument for overcom- 
ing stricture, or prostatic obstructions. It should be 



386 Stricture. 

passed every three or more days, and allowed to remain 
each time for about 5 minutes, by which time the pa- 
tient may complain of faintness. This procedure (un- 
der chloroform if necessary) must be repeated with a 
gradual increase of the size of the instrument, until the 
canal is restored to its natural calibre — it is expedient 
to pass a sound once a fortnight for a few months af- 
terwards. If the stricture is very old, hard and grizly, 
or in cases of very irritable urethra, or where there is 
a false passage already, metallic sounds are preferable. 
Electrolysis (p. 148) is now recommended as a sure 
remedy, on the supposition that a chemical decompo- 
sition of the strictured part is produced by the negative 
electrode, resultiug in a scar, which is soft and but 
slightly or not at all retractile., similar to that, resulting 
from alkalies; whilst the cicatrix produced by the posi- 
tive pole, is as hard and retractile as one caused by 
acids or burns. The lumen of the stricture is enlarged 
by a dissolution of cicatricial tissue, and the character of 
that tissue so altered that it no longer contracts. The 
sittings should take place at intervals of, from a fort- 
night to a month, and only mild currents should be used. 
The exposed end of the bougie-electrode, which con- 
sists of a stiff but pliable piano or copper wire, insulat- 
ed with gum elastic or soft rubber-material, should be 
egg or acorn-shaped. For the treatment of Spasmodic 
Stricture, which may be due to wet and cold, irritating 
urine, gout, sexual excitement, piles, ascarides, and oth- 
er sources of intestinal irritation, see Bladder, (Reten- 
tion of urine). If from gonorrhoea or indulgence in liq- 
uor, or cantharides — whether taken internally or ap- 
plied as blister — this form is usually associated with 



Syncope. 387 

inflammation. For Stricture of female urethra, see Ure- 
thra; for Stricture of rectum — Rectal Diseases; of Cer- 
vix Uteri — Uterus; etc. 

Subinvolution of Uterus. See Uterus. 

Subsultus tendinum — Movements of the wrist, per- 
ceptible to the touch, constitute one of the ataxic symp- 
toms in typhoid, which denote gravity. Subsultus is 
usually associated with grasping at invisible objects 
(carphologia^) and fumbling with the bed-clothes, etc. 

Summer complaint. See Cholera Infantum. 

Sunstroke. See Insolatio. 

Suppression of Menses and of Urine. See Amenor- 
rhoea, resp. Ischuria. 

Suppuration — One of the terminations of inflamma- 
tion, the product of which is pus; and though essential- 
ly a morbid process, it is customary to speak of healthy 
pus, if it accompanies the beneficial process of granula- 
tion. See Abscess. 

Sweat. Profuse or Stinking. See Ephidrosis. 

Syncope — Complete and sudden loss of sensation 
and motion with diminuition or suspension of the pul- 
sations of the heart and respiratory movements, charac- 
terized by a death-like pallor of the face — convulsions 
even may occur — and due to a sudden deficiency of ar- 
terial blood in the brain, caused by either, direct loss of 
blood or by too feeble action of the heart. Treatment 
— Recumbency, with the head low down and some cold 
water dashed in the face, with perhaps some stimulant, 
brandy, ether (36); or Ammonia (pp. 44 & 73) will gener- 
ally suffice to shorten a fit of fainting. Compression of 
the abdominal aorta and of the arteries of the upper ex- 
tremities may sometimes be required. See Insolatio. 



388 Syphilis. 

Synovitis. See Joints. 

Syphilis — Whilst the soft chancre may stand as the 
type of a spreading ulcer (see Chancroid), the true or 
hard chancre may be an insignificant pimple, which, 
however, is the starting point of a peculiar cachectic 
state of the system, called Syphilis, creating a multi- 
plicity of diseases, which is just as astonishing as it is 
with regard to the time in which they may appear, or to 
the difference in the severity; and due to a specific vi- 
rus, usually communicated by impure sexual intercourse. 
As a rule the primary sore, which is characterized by 
a circumscribed induration with very scanty discharge, 
if any— ulceration, inflammation and suppuration, if 
present, being accidental — -and healing without medica- 
tion, is situated somewhere on the genitals; but it may 
be met with on the lips, the fingers and elsewhere. The 
sore is mostly accompanied by inflammation of the 
glands in the groin (bubo), which is usually multiple 
and indolent. About six weeks after this primary affec- 
tion, secondary symptoms make their appearance: A 
crop of copper-colored blotches on the skin of the arm 
or chest; raised mucous patches on the lips, palate or 
throat; scabs from little pimples on the scalp and fail- 
ing of the hair, attended with more or less malaise, 
headache or rheumatism. When the first outbreak has 
disappeared, there is a liability of a relapse and a fresh 
set of symptoms: perhaps iritis; nodes on the bones; 
scaly patches on hands and feet with headache and pains 
in the bones. However there is no invariable order, for 
periostitis may be the first and only symptom, with no 
eruption whatever. Rarely six months will pass before 
the first outbreak appears; but sequelae may occur after 



Syphilis. 389 

more than twenty years. As regards the diagnosis of 
chancre, it has to be borne in mind that the syphilitic 
character of the primary lesion, whether it consist in 
a raised pimple, a fissure, a shallow ulcer or a mere ex- 
coriation, may not be apparent for some weeks; and 
moreover, that some other lesion may co-exist. Herpes 
prceputialis, which may be confounded with chancre, 
begins with extreme itching and a sense of heat; the 
red patches are soon surmounted by minute, very trans- 
parent vesicles, which in about 24 hours having become 
larger and opaque, will be confluent on the -third day, 
and break a few days later leaving a slight ulcer: This 
being touched with caustic, may become hard like that 
of chancre. Again, there may appear on the prepuce 
minute aphthous-looking points, which do not pain and 
are perfectly harmless, though they may be rather ob- 
stinate, some of them healing, while others are break- 
ing out. Psoriasis prcejnctii, consisting of very painful, 
irritable and bleeding cracks or fissures around the 
edge of the prepuce must not be forgotten. From ba- 
lanitis, chancre is easily to be discriminated by the ex- 
tent of the excoriations, and — if phimosis be present — 
by the profuse discharge and the pain being not con- 
fined to one spot, which are diagnostic of the former. 
Finally it should be recollected that, as chancre may in- 
fect the smallest, hard, discolored spot, crack, fissure, 
etc., anywhere, an enlargement of the nearest lymphat- 
ics should be looked for — above the elbow if the finger 
be infected, below the jaw if the lips. Treatment — As 
the primary sore will heal of itself in three to six weeks, 
any simple application will do, be it Sod. Bicarb, or 
Calomel (286 & 329), Mercury internally will hasten the 



390 /Syphilis. 

healing process; but as it by no means will avert sec- 
ondary symptoms, and moreover, inflammation or spread- 
ing ulceration forbid its use (see Chancroid) it is gener- 
ally safer to do without it; unless one believes in small 
doses of Hydrargyrum cum Creta, which is said to pre- 
vent induration, when exhibited for about six months 
(p. 12). For the treatment of inflammation of the in- 
guinal glands, see Bubo. For the various eruptions the 
steam hath is a good auxiliary; and if pimples or patches 
should prove very obstinate, Ungt. Hydr.nitr. more or less 
diluted, will accelerate the cure. For loss of hair a po- 
made containing a little of the same ointment will be 
useful. Condylomata (see Warts — Skin), and ulcers 
require applications of Mercury (286 & 353); Cuprum 
(340 & 47): Cocaine (330); or Mangan (402); and Acid, 
nitric, especially in foul ulcers of the velum and alee 
nasi. In sore throat, caustic (288); or Sublimate (286, 
298 & 371'). For gummata Iodine (401 & 2). The 
pain of nodes is frequently relieved by blisters. The 
remedies for constitutional syphilis are Mercury, Iodine 
and Chrom (pp. 12-14 & 110); Aurum (3) Sarsaparil/a 
(1); and tonics — Quinine (pp. 75 & 6) Acid, nitro-mur. (p. 
71); etc. Mercury should not be given, if the general 
health be much impaired; and it should be suspended or 
abandoned altogether, if robust persons get thinner, 
weaker and haggard under its use. 

Tabes dorstjalis. See Ataxia loco-motor. 

Taenia (Tapeworm). See Helminthiasis. 

Teeth — Toothache ( Odontalgia) from inflammation 
of the pulp is characterized by agonizing pain, the teeth 
becoming tender and loose; the periosteum and gum 
inflamed, and an abscess may form. See Parulis 



Temperature. 391 

(Mouth). Treatment — Creosote, Cajeput, Chloroform, 
Cocaine (285) etc. on cotton inserted into the pulp-cavi- 
ty are the usual remedies. Neuralgic toothache, which 
is very common in the earlier months of pregnancy and 
characterized by paroxysms, is best treated by large 
doses of Quinine (p. 11) together with aperients (p. 88) 
and alteratives. Gelsemium (p. 33) is much recommend- 
ed. The rheumatic form, which is characterized by the 
pain "flying about the jaw," and affecting several teeth 
in turn, will be relieved by blue -pi I I and aperients with 
small doses of Colchicum (p. 90), followed by Ammon. 
hydrochlor. in half-drachm doses every four hours, or 
Iodine (18). Caries — a softening and decay, which 
will gradually spread till it reaches the central cavity 
of the tooth — requires filling; and Necrosis — if the tooth 
is black, unsightly and loose in the socket — demands 
extraction in case of causing inconvenience. For Teeth- 
ing see Dentition. 

Telangiectases, where there is very little or no peri- 
vascular connective tissue new growth (see Naevus) may 
more or less be destroyed by scarification, linear or 
punctate, as in acne rosacea, and with or without Chrom 
or Phenol on the needles, as sometimes used in pigment- 
ary deposits. However it may be well to inject Cocaine 
(247) or freeze the part with ether spray before opera- 
ting. Pressure will control the subsequent bleeding. 
Afterward the part is to be washed with alcohol and 
covered with a thick layer of Collodion (415). 

Temperature — If the normal heat of the body be 
measured within the axilla and taken as ranging be- 
tween 97.5' to 99.5' (in the rectum and vagina the temp, 
will be about one degree higher) 101° will indicate a 



392 Temperature. 

febrile state of a mild form, and as the degree of tem- 
perature bears a direct relation to the amount of waste 
products furnished by the body, a rise of the ther- 
mometer above this, will be proportionate to the severi- 
ty of the pyrexia. Hyperpyrexia, the temperature call- 
ed of, and above 107.5°, which sometimes occurs in 
rheumatism, scarlatina and pyaemia or after some inju- 
ries of the brain, is usually a fatal sign. The lowest 
extreme of temperature (77°) is occasionally met with in 
the cold stage of cholera. It also falls suddenly in some 
cases of pneumonitis, typhoid and puerperal fever. A 
fall of the temperature is considered more grave than 
a like rise, one degree below the standard denoting even 
more danger than 2-J- above. In order to measure the 
temperature, which is usually higher in the evening 
than in the morning, and which can best be ascertained 
between 7 and 9 a. m., and between 4 and 6 p. m., the 
thermometer should be left in the axilla for at least 
three minutes, remembering at the same time, that the 
pulse may rise ten beats per minute for every degree of 
the thermometer. 

Tenesmus — An urgent and distressing sensation, as 
if a discharge from the intestines, resp. bladder must 
take place, although none can be effected. See Dy- 
sentery and Bladder. 

Testicles (Testiculi — Didymi) — Acute inflammation 
of the testis — Orchitis seu Hernia humoralis — is char- 
acterized by aching pain, involving the cord and ex- 
tending to the loins, followed by swelling of the epi- 
didymis (Epididymitis), with exquisite tenderness, vom- 
iting and fever. It mostly occurs in conjunction with 
gonorrhoea through an extension of inflammation from 



Tetanus. 393 

the urethra; especially in persons who indulge in liquor, 
or neglect wearing a suspensory while employing injec- 
tions. Treatment — Suspensory bandage and ice with 
leeches, if necessary, and purgatives (p. 8$), Antimony 
and Opium (pp. 83 & 3 7). Afterwards Lead and Opium 
(337) or Belladonna ointment (350). A deep puncture 
made into the body of the testis with a thin, sharp 
knife relieves instantaneously, and requires as after- 
treatment only an aperient w 7 ith cooling lotions. After 
the acute stage compression by means of strips of ad- 
hesive plaster: The uppermost strap being placed round 
the spermatic cord immediately above the testicle, and 
the skin protected by a strip of lint to prevent cutting, the 
straps are applied in the long axis of the testis, radiat- 
ing across the centre of the scrotum below, so as to cover 
the whole organ. Chronic inflammation of the testis 
(Sarcocele) is characterized by more or less tenderness, 
swelling and hardness, with occasional pain, and fre- 
quently accompanied by some effusion (Hydro-sarcocele). 
Unless a sequel of the acute form, it may be caused by 
chronic rheumatism or syphilis, but generally it is due 
to stricture of the urethra. Treatment — Aside from the 
constitutional treatment and the wearing of a suspensory, 
cold lotions, Tinct.Jodi, Iodoform (401^ etc. Barium (5) 
is said to be useful. Neuralgia of the testis and cord, 
which is characterized by paroxysms of pain with ten- 
derness and slight swelling, requires aside from leeches, 
lotions and Opium and Belladonna ointment, tonics: Qui- 
nine (p. 76); Ferrum (p. 7 9), etc. 

Tetanus is characterized by persisting rigidity of 
the muscles of the jaw and of the greater part of the mus- 
cles of voluntary motion, with paroxysms of tonic spasms, 



394 Tetanus. 

probably owing to an intensely increased excitability of 
the spinal cord. If confined to the 5th and 7th nerves, it 
constitutes lock-jaw (trismus), affecting the muscles of 
the neck and lower jaw. The mouth in some of these 
cases cannot be opened by any force and its angles are 
drawn backward and upward, causing the expression 
called "risus sardonicus." In the paroxysms of spasm, 
which are superadded to the persistent rigidity of the 
muscles, the body is generally bent backwards, (opistho- 
tonos), sometimes forward (emprosthotonos) , seldom 
sideways (pleurosthotonos) . Aside from the idiopathic 
form, due to cold and visceral irritation (especially of 
the womb), it is most liable to follow lacerated, poison- 
ed, and punctured wounds of the hands and feet; gun- 
shot wounds; compound fractures; the pressure of bul- 
lets and foreign bodies. Treatment — Above all remov- 
al of cause. Of remedies may be named Curare (65), 
Amy/ (308), Chloral and Chloroform (p. 30), or Brom 
(p. 24); Opium (p. 35) and Strychnos (p. 83). If from 
strychnine poison, see Table (p. 6). At the same time 
nutrient enemata (387) and brandy (p. 73), etc. If chron- 
ic, shower bath, aperients (p. 88) and tonics* (p. 69); 
Cannabis or Gelsemium (pp. 28 & 33) and Physostigmine 
(256). In hysterical tetanus Valeriana (p. 38) Hyos- 
cyamus (p. 33) and aperients. In trismus infantum seu 
neonatorum, whether due to the mother's milk, the re- 
tention of meconium, or the inflammation of the umbilical 
arteries from tying, it is nearly always fatal: The warm 
bath, Castor oil, Physostigmine and Chloroform (256 & 
316) or Opium (p. 37) are the usual remedies. 

Throat. See the affections of the various parts, 
which are generally enumerated under that head: 



Tonsillitis. 395 

Pharyngitis, Laryngitis, Catarrh (Cold in the throat), etc. 

Thrush (Stomatomycosis). See Mouth. 

Tic douloureux. See Neuralgia (trifacial). 

Tinea. See Head. 

Tinnitus aurium. See Ear. 

Tongue. (See Mouth) — The tongue furnishes most 
valuable diagnostic hints: If thick and flabby, showing 
indentations from pressure of teeth, it indicates gastric 
and nervous irritation; if sharp and pointed- irritation 
or inflammation of the brain; if pale-anaemia; affections 
of spleen; and after severe hemorrhages, if very red — 
inflammation of the gastric or intestinal mucosa; if red 
or a white coating, with prominent papillae (strawberry- 
tongue) — scarlatina; if red on edges and tip, or a red dry 
streak in centre — typhoid and gastric fevers; a thick, 
white coating — gastric derangement; a thick, yellow 
fur — biliary derangement; a dark, brown coating — ma- 
lignant fever; if dry, blackish and tremulous— abdomi- 
inal typhus; if lead-colored — cholera and mortification 
of lungs and stomach; if bluish — impeded circulation; 
if aphthous — thrush of infants; visceral diseases tend- 
ing towards a fatal termination; and last stage of 
phthisis. If the tongue is protruded very slowly and 
not drawn back again — exhaustion or congestion or 
some pressure on the brain; if tremulous — in acute dis- 
eases of evil import; if, when protruded, it points to one 
side — hemiplegia of the organ; immobility and tremb- 
ling — torpor of the brain. 

Tonsillitis [Quinsy) — Inflammation of the tonsils, 
mostly due to cold, is characterized by redness, rapid 
swelling of the part, throbbing pain when matter is 
formed, difficult deglutition, with foul tongue, head- 



396 Tonsillitis. 

ache and fever. Treatment — Cold compresses and ice to 
be sucked or hot fomentations, inhalations of steam , with 
gargles (300) and a brisk purgative. Aconite or Anti- 
mony (p. 23); Hydrarg. c. Creta (p. 13). An application 
of Argentum nitricum (1:4 Aqua) will generally reduce 
tension and pain; probably prevent suppuration; and if 
done within the first twenty-four hours, may even abort 
the disease. As diet, milk, gruel and broth. If the 
gland continues to swell or occasions embarrasment to 
breathing, an incision should be made to unload the 
vessels and give exit to matter, if present: The tongue 
being kept down with the left forefinger, a straight bis- 
toury, wrapped round with lint, except an inch and a 
half of its point, is passed directly into the tumor, and 
made to cut its way out towards the median line. 
Chronic follicular tonsillitis, being characterized by 
small white bodies, projecting from the orifices of the 
follicles is generally connected with the so-called Cler- 
gyman^ s sore throat, see Pharyngitis. Chronic enlarge- 
ment of the tonsils is a frequent sequel of inflammation, 
especially of repeated catarrh in scrofulous children, 
and leads often to throat-deafness. Aside from a tonic 
treatment, as Ferrumjodatum (p. 14) Quinine (p. 76) 
Cod liver oil etc., astringent gargles (299); inhalations of 
hot water with twenty drops Creosote or Tinctura Jodi; 
Argentum nitricum (gr. xx: § j Aqua) ; or Tinctura Jodi by 
means of a sponge-probang; or a submucous injection 
of Iodine (292). 

Toothache (Odontalgia). See Teeth. 

Tophi arthritici. See Arthritis. 

Torticollis. See Wry-neck. 

Trachoma. See Eye. 



Trichinosis 397 

Trance. [Ecstasy) — A condition in which the mind, 
absorbed in a dominant idea, becomes insensible to sur- 
rounding objects, the body remaining in some cases, 
immovably fixed, as in catalepsy. 

Tremor — Alternate contractions and relaxations of 
muscles in rapid succession. Aside from being inci- 
dent to old age or due to poisoning with mercury — 
Tr. mercurialis — , or as consequence of certain lesions 
of the brain, it occurs as a result of the abuse of spir- 
its, habitual use of opium, nicotism and sexual excesses, 
when it is functional, the tremulousness affecting es- 
pecially the hand, seldom extending to the lower ex- 
tremities. Treatment — Removal of cause, if possible, 
and tonics (p. 69); in Tr. mercurialis, Iodine (p. 14); in Tr. 
senilis, Morphinum and Zinc (80 & 195) may be tried. 
Trembling, characterized by f eebl e, rapidly recurring and 
rhythmical movements, increased under mental excite- 
ment and physical exertion, and followed sooner or la- 
ter by paresis is called shaking palsy or Parkinsons 
Disease {Paralysis agitans). Here the remedies are: 
Tonics — Arsenic (p. 9) Barium (p. 10); Strychnos (p. 83); 
or Ergot (p. 78); and sedatives — Belladonna, Brom, Canna- 
bis, Chloral etc, (pp. 23-30). 

Trichiasis. See Eye. 

Trichinosis — (Trichiniasis) is a disease caused by 
Trichina spiralis, a parasite of about 1 mm. in length, 
which, belonging to the class nematoda, is found in the 
muscles of swine. The disease is characterized by ab- 
dominal pains, vomiting and diarrhoea, followed "soon 
by pains in the muscles, together with more or less con- 
stitutional disturbance. The symptoms occur within 
ten days after eating trichinous pork in an uncooked or 



398 Tuberculosis. 

not sufficiently cooked state, that is, as soon as the young 
worms have been produced and become developed, so 
as to begin their migration towards the muscles. The 
parasites, having been in the muscular tissue of the pork 
in a quiescent state — coiled up within a cyst — by the 
process of digestion are set free in the stomach, whence 
they pass into the intestines, where they prodigiously 
increase in size and number, They then penetrate the 
mucosa of the intestine, and rapidly find their way to 
the different muscles, where they become again encyst- 
ed, and though quiescent, will retain their vitality for 
an indefinite time. Treatment — The usual remedies 
employed, are Bpnzin, Phenol and Salicin (pp. 103 & 105). 

Trichomycosis (Tinea Sycosis). See Head. 

Trismus. See Tetanus. 

Tuberculosis is an infectious disease, caused by the 
tubercle bacillus, and characterized by the production of 
tissue and of inflammatory products, which appear both, 
in the form of nodules and as a more diffuse inflamma- 
tion, and which rapidly undergo caseation. Treatment 
is essentially of a hygienic nature in conjunction with 
tonics, especially Ferrum and 01. Jecoris (pp. 15, 79 & 
84), whatever the seat of the local process may be. See 
Chronic Laryngitis and Phthisis (Larynx & Lungs). 

Tumor signifies increase in volume by the growth of 
new tissue, which does not perform any physiological 
function. As swellings, due to inflammatory processes, 
(Edematous infiltration or hypertrophy, etc. are no real 
tumors, though frequently called >so in "common par- 
lance," their description with treatment will be found 
elsewhere, T. albus — Joints; encysted, vaginal — Vagi- 
na; vulvar and pelvic bloody — Hematocele; vascular of 



Tympanites. 399 

meatus (urethral caruncle) — Urethra; fecal (retained fe- 
ces) — Constipation, etc. Treatment according to the 
nature of the growth; in some cases parenchymatous in- 
jections of Phenol (239) are recommended. In malig- 
nant forms, Argentum nitricum (403) or an injection of 
an acidulated solution of Pepsin? For ovarian tumors 
see Ovaries; for malignant tumors — Carcinoma. 

Tympanites (Meteorismus) — An accumulation of gas 
in the stomach, small intestines or peritoneum. If in 
the latter, it constitutes sometimes a most distressing 
symptom of peritonitis, which may easily be distinguish- 
ed from the other forms by the disappearance of the 
liver sound, on percussion, the tympanitic resonance hav- 
ing extended over that organ, so as to change at once 
into the full lung-tone. Barring this, and those forms 
which develop occasionally in other acute diseases, tym- 
panites occurs mostly in dyspeptic disorders, and in 
connection with some uterine diseases. If indigestion 
be the cause, the gas is derived from either, putrefac- 
tive or fermentative changes in the ingesta; if irrita- 
tion of the uterine nerves, the abdominal ganglia, to- 
gether with the solar and semi-lunar plexus may be sec- 
ondarily affected, in consequence of which the diges- 
tive functions suffer, leading to sudden secretions of gas. 
(The disability to expel the gas is the consequence of a 
paralytic state of the muscular fibres of the intestines 
due to over-distention or defective nerve-power, see 
Hysteria). Treatment according to cause — Vegetables 
and other articles of diet, which easily ferment, must be 
avoided. If hysterical, tonics, especially Iron and Qui- 
nine (pp. 76 & 79). Sometimes a tumblerful of cold 
water by its tonic impression on the intestinal canal will 



400 Typhlitis. 

be of service. Or Aloes, Colocynthis and Jalap (pp. 89, 
90 & 96). In very troublesome cases, an elastic tube 
may be introduced into the rectum and carried up the 
bowels for several inches above the promontory of the 
sacrum, which will give immediate relief, unless there 
is excrementitious matter in the intestines, which must 
be removed by Terebinthina (217 & 385). See Dyspepsia. 

Typhlitis ( Typhlo-Enteritis, Ccecitis) — Inflamma- 
tion of the ccecum is characterized by pain and tender- 
ness corresponding to the situation, attended by vomit- 
ing, diarrhoea, and more or less fever. It is generally 
associated with inflammation of that portion of the pe- 
ritoneum, which covers the ccecum, with the additional 
symptom of circumscribed tympanites in consequence 
of paralysis of the muscular tunic; and chiefly due to 
detention of feces and the presence of irritating sub- 
stances. Sometimes it leads to fecal abscess (Perity- 
phlitis). Treatment — Rest; poultices and mild laxatives 
— 01. Ricini or small doses of Salts; or what is still bet- 
ter three times daily an enema, given through a long 
flexible tube, which is carried upward to the sigmoid 
flexure. For pain, Opium (p. 35); if an abscess is form- 
ed, aspiration as soon as fluctuation is felt. 

Typhoid (Typhus abdominalis—Ileo-typhus) — Con- 
tinued or enteric fever is an infectious disease, mostly 
due to drinking of polluted water, with lesions of the 
intestinal lymphatic structures, which are specific and 
always associated with enlargement of the mesenter- 
ic glands, especially those in immediate relation to 
the Peyerian patches and solitary follicles, and charac- 
terized by a long prodromic stage: Chills, irregularly 
recurring, and followed sometimes by perspirations; 



Typhoid. 401 

loss of appetite, mental irritability, frontal headache, 
with pains in the loins and limbs; looseness of bowels, 
and frequently epistaxis. In the first days of the fever 
wakefulness is a prominent symptom; this is soon fol- 
lowed by a pseudo-somnolent state (coma-vigil) and a 
kind of muttering delirium (typho-mania), with car- 
phologia and subsultus tendinum, terminating occasional- 
ly in true coma. About the 7th day from the time of 
taking to the bed, there appear usually on the chest iso- 
lated papules of a pink color, whilst in the latter part 
of the disease miliary vesicles (sudamina) are common. 
A gradual rise from dag to day of the thermometer, 
with its oscillations of about one degree and a half be- 
tweeen morning and evening temperature for the first 
week is diagnostic; and so is tympanites, tenderness or 
pain and a gurgling noise, on pressure in the ileo-coe- 
cal region with the diarrhoea, which looks not unlike 
pea soup. There may be however constipation and 
sometimes hemorrhage from the bowels. Walking 
cases of typhoid (Typhus ambulatorius) are those, in 
which the symptoms are so slight, that the patient need 
not take to the bed. Barring complications, which are 
many and various, the treatment is the same as employ- 
ed in all essential fevers — Aside from Quinine (p. 11); 
Saficin (27 &29); Baptisia (4); Veratrum (p. 39); etc., 
Sponging, or the wet sheet with sprinkling, or the pack 
(420), whenever the axillary temp, reaches 103°, or that 
of rectum 102^°. At the same time supporting meas- 
ures: Brandy (p. 72) and food at intervals of from 2-4 
hours — milk, eggs, broth, etc. If headache, the ice- 
cap, if insomnia or delirium, Opium, Brom or Hyoscyamus 
(pp. 27, 33 & 35); Antimony or Digitalis (pp. 23 & 50). 



402 Typhoid. 

Constipation requires enemata (385); diarrhoea, Alum or 
Bismuth (pp. 46 & 62); tympanites, which depends on a 
paralytic condition as result from enteritis or peritoni- 
tis, may be relieved by Terebinthina (pp. 68, 95 & 137); 
and externally with hot fomentations. Hemorrhage de- 
mands astringents — Ergot, Creosote or Plumbum cum 
Opio (pp. 64-67), or Terebinthina and cold compresses 
to abdomen; coma, blisters (408) or sinapisms to nuka — 
if dependent on uraemia, saline hydragogues (p. 96) un- 
less contra-indicated by abdominal symptoms, in which 
case Pilocarpin (p. 50). 

In children and infants a warm bath will generally 
answer better than a cold one or the pack; but very of- 
ten cold applications to the heart are quite sufficient to 
reduce the temperature. Quinine should only be em- 
ployed in persistent enlargement of the spleen, as it is 
liable to produce diarrhoea or tenesmus. Antipyrin may 
be given instead, but in conjunction with a cardiac 
stimulant, in order to avoid any debilitating effect on 
the heart: gr. v ter v. quater die to child of three years. 
In tympanites, cold applications or enemata of cold wa- 
ter are sometimes serviceable, though as a general rule 01. 
Terebinth. (385) will do more good. In diarrhoea Naph- 
tha! in gr. ss-j bihorio] or Saiol gr. j-iij at the same in- 
tervals, will generally improve the stools and diminish 
their number. Constipation should, as a rule, not be in- 
terfered with, at any rate, if peritonitis present; other- 
wise enemata of warm water, perhaps with 01. Terebinth. 
will usually suffice in the most obstinate cases. Or 01. 
Ricini 3 ss-j every few hours; or small doses of Calo- 
mel (gr. ss-j). Perforations require aside from cold 
compresses to abdomen and hot applications to feet, 



Ulcer. 403 

Opium in conjunction with stimulants; hemorrhage should 
be treated with ice to the right hypochondrium, and in- 
ternally, Alum or Plumbum with Opium and Digitalis 
(p. 50). Half a minim of Tinct. Opii every hour or 
two, will act both as a cardiac-stimulant and astringent. 
When there is the slightest brain complication not de- 
pending on the infection itself or anaemia, neither opium 
nor alcohol must be given, though it may appear indi- 
cated by the condition of the heart; however the for- 
mer is well tolerated, and relieves sleeplessness and the 
general irritability, if the cerebral symptoms belong to 
anaemia or to the infection alone. Before the tenth day 
after the fever has disappeared no solid food should be 
allowed. Raw fruit must not be given under any cir- 
cumstances; and the little patient should be kept still in 
bed for at least a fortnight after the disappearance of 
the fever. 

Typhus {Typhus exanthematicus — Ship fever, etc.), is 
a continued fever, usually due to contagion in conjunc- 
tion with broken health from deprivations and hard- 
ship incident to poverty. The symptoms during the de- 
velopment of the disease are essentially those of ty- 
phoid, with the exception of the pathognomics of that 
disease. Moreover the prodromic stage is very short or 
wanting; and a copious persisting eruption (if present) 
of dark red macular appears already in the first few 
days of this fever, the skin assuming nearly all over a 
dusky hue. Treatment similar to that of typhoid; Sali- 
cin (p. 18) is particularly recommended. 

Ulcer — An open sore from softening and disinteg- 
ration of structure in consequence of a wound, bruise, 
abscess, injury or disease. Treatment — Cleanliness, 



404 Ulcer. 

rest, bandaging or strapping and exclusion of air, with 
purgatives, and if necessary anodynes for the relief of 
pain in conjunction with proper attention to the gener- 
al health, are the chief points. The healing ulcer or 
common sore should be covered with dry lint, if there 
be much discharge; else a dressing with simple oint- 
ment or Ungt. Zinci, which should not be changed oft- 
ener than every three days. If the granulations should 
be too luxuriant, it may be touched with lunar caustic; 
or it may be treated with lotions {Zinc or Phenol, etc). 
Inflamed and irritable ulcers require poultices, with or 
without Poppy, Opium or Conium; afterwards Liquor 
Plumbi or Blackwash (400). The foul or sloughing ul- 
cer is best treated with Bismuth, Creosote, Mercury, Re- 
sorcin, Phenol or Salicin (393-399). The indolent sore 
requires similar applications, after having applied strips 
of adhesive plaster two-thirds round the limb, from one 
inch below the ulcer to one inch above it. A thick lay- 
er of phenol-gauze should be put over the dressing, af- 
ter which the limb has to be bandaged from the toes to 
the knee. Varicose ulcers of the leg must be band- 
aged. In syphilitic and scrofulous ulcers Iodoform (401) 
is usually employed. For ulceration of bladder, see 
Bladder; for ulceration of cervix — Uterus (Degenera- 
tion); of cornea — Eye; etc. 

Ulcus ventriculi (Gastric ulcer). See Stomach. 

Umbilicus (Prolapse and Bleeding). See Hernia um- 
bilicalis, resp. Menstruatio vicaria. 

In the new-born the navel will sometimes suppurate, 
even before the stump has dropped off, which, unless 
arising from want of cleanliness, is generally due to a 
leucorrhceal discharge from the vagina of the mother. 



Urethra. 405 

In syphilitic infants the navelstump, inteadof mummi- 
fying on the fourth or fifth day, as is normal, will remain 
soft and attached for perhaps more than a fortnight, 
thus exposing them to navel inflammation and septic 
infection. To prevent such a gangrenous or putrid con- 
dition, not only the cord should be tied with an aseptic 
ligature (416), and cut with scissors, which have been 
made aseptic by passing them through a flame; but also 
the stump should be wrapped in a piece of burnt linen 
(with a hole for its passage), after having been washed 
with bor water (260), and cautiously dried. If in spite of 
these precautions the navel should ulcerate, or proud 
flesh sprout from its side, the part must be dusted twice 
a day with Calomel (400). Argenium nitricum 2%, as 
used for the prevention of gonorrhoea! ophthalmia, is 
also recommended. 

Urjemia — Uremic poisoning is characterized by 
coma, epileptiform convulsions and sometimes delirium, 
even amaurosis, preceded generally by headache, vom- 
iting and diarrhoea. It is due to an accumulation of ex- 
crementitious substances, especially urea, in the blood, 
in consequence of impaired or interrupted functions of 
the kidneys. The urine contains albumen and as a rule 
dropsy is present. For treatment see Coma. 

Urethra (Male). See Gonorrhoea resp. Stricture. 

Urethra (Female) — Urethritis in women occurs 
mostly after hard labor; but it may be also a conse- 
quence of a faulty introduction of the catheter during 
pregnancy, and is characterized by great tenderness on 
passing the finger along the course of the urethra; more 
or less discharge, and frequent micturition. Treatment 
consists in saline purgatives (p. 95); diluents — Nitrum 



406 Urethra. 

gr. x ter die in Decocto Lini; Aconite (35) and perhaps 
Buchu (p. 47). Locally Argenium nitricum (364), espe- 
cially if there should be some ulceration at the border 
of the meatus. 

Prolapsus Vrethrce known also as procidentia and 
eversio urethrce consists of prolapse of the mucous mem- 
brane, which encircles the meatus like a roseate projec- 
tion, and unless the result of hard labor, depends on a 
relaxation of the part in connection with a broken-down 
health. It is characterized by much sensitiveness, 
great liability to bleed, and difficult and painful mic- 
turition. Sooner or later it may cause pruritus vulvas, 
with a leucorrhoeal discharge and even ulceration from 
the parts being exposed to friction of the dress, etc. 
From caruncle, polypus or angioma it may be easily 
differentiated by its entirely surrounding the meatus. 
Treatment — The patient being anaesthetized, the pro- 
lapsed tissue should be drawn down with tooth-forceps 
and removed by encircling it with the galvano-caustic 
wire, placing for some days a catheter in the bladder if 
necessary. Existing ulceration should be treated first 
with caustic. Sometimes astringent injections (359 et 
seq.) with attention to the general health will effect a 
cure — Magnesia (218); Ferrum (175); etc. 

Urethral Caruncle — A vascular tumor, soft and frag- 
ile, varying in size from that of a pea to that of a pul- 
let's egg, situated on the border of the meatus, some- 
times extending up the canal. It is almost always ac- 
companied by a mucous discharge, excessive pain in 
sexual intercourse, in walking and micturition; and will 
sooner or later affect the general health by causing ner- 
vousness and depression of spirits. Treatment — After 



Urine. 407 

having covered the adjacent parts with hardened lard, 
so as simply to expose the tumor, it is freely touched 
with Acid, nitric. (329), which may be repeated after a 
few days if necessary; or it may be cut off, and Potassa 
fusa, or solid Cloride of Zinc, applied to the surface, to 
prevent its reproduction. If Potass has been employed 
the parts should, after its use, be washed with diluted 
vinegar; if Zinc, they should be well oiled. If it is 
necessary to introduce the caustic within the urethra, it 
must be by means of a porte-caustic. The best opera- 
tion is however with the galvano-cautery, since by this 
means the hemorrhage, which is sometimes very pro- 
fuse, is not only stayed, but a relapse is also prevented. 
Before the operation the patient should be thoroughly 
anaesthetized, and the labia well separated by an assistant 
on each side. When the urethra has been invaded, it 
should be thoroughly stretched by small retractors, held 
by assistants, and the growths thus exposed be cut off 
with scissors, or scraped from their attachment by a 
steel curette. After removal they should be touched 
with Arg. nitr. y Acid, nitric, fumans, or the actual cautery. 
Angioma, which affects the urethro-vaginal tubercle or 
anterior half of the urethro-vaginal septum, attaining 
sometimes a large size, so as to project between the la- 
bia, requires the same treatment. It can easily be dif- 
ferentiated from caruncle by its want of sensitiveness. 

Stricture, which is characterized by difficult mictu- 
rition, pain upon pressure along the urethra, and some- 
times a mucous discharge, is best treated by mechanical 
dilatation with graduated bougies. 

Urine (see page 154) — Incontinence occurs in most 
inflammatory affections of the urinary organs, nervous 



408 Urine. 

diseases, paralysis, etc., see Bladder; for Retention, 
(inability of expelling the urine, though the bladder is 
filled), being due to deficiency of contractile power of 
the bladder, stricture of the urethra, etc., see Reten- 
tion; for Suppression from inaction of the kidneys, the 
bladder being empty, see Ischuria; and for Hcematuria 
(the passage of blood with the urine), see Hemorrhage 
from the kidneys. 

Urinary Deposits, if precipitated from the urine, af- 
ter it has been voided, are called sediments; if how- 
ever already formed in the bladder or kidneys, they are 
known as gravel. Red gravel, consisting of lithic or 
uric acid crystals, tinged with coloring matter, indicates 
generally a highly acid state of the urine, and forms the 
sediment observed in fevers, gout and chronic diseases 
of the liver. It may exist with highly plethoric condi- 
tions, and may, on the other hand, be a sign of debility 
and malassimilation. The amorphous lithates of ammo- 
nia, soda, and lime, form a very common sediment, vary- 
ing in color from nearly white or yellow to dark red. 

Oxalate of lime, presenting letter-envelope-like crys- 
tals, which are easily recognized under the microscope, 
is generally deposited from acid urine containing lith- 
ates, and indicates feeble assimilation and exhaustion of 
the nervous system. The phosphatic deposits, aside from 
being a result of irritate bladder w T ith excessive secre- 
tion of mucus, caused by a primarily over-acid urine, 
which on account of its urea being decomposed into 
carbonate of ammonia, has turned alkaline, are due to a 
primarily alkaline, or insufficiently acid state of the urine, 
mostly dependent on excessive acidity of the stomach. 
Unless arising from changes in the bladder, the 



Uterus. 409 

phosphates usually indicate anaemic dyspepsia or undue 
wear-and-tear of the brain from overwork. 

A fit of gravel is generally accompanied by pains in 
loins and hips; aching of the testicles; and frequent 
micturition. Sometimes there is languor, fits of headache, 
sour perspiration and nettle-rash, with despondency and 
other symptoms of indigestion, or a disordered state of 
the constitution; especially in Oxaluria. Treatment ac- 
cording to causation — In red gravel of robust and strong 
persons, aside from a bland diet, Liquor Potasso (119); 
or Benzoin (pp. 45 & 46 & 58) with occasionally a purga- 
tive (p. 97). In feeble persons a nutritious diet with 
tonics (p. 69), especially Acid, nitro-mur. (pp. 42 & 43), 
which is also indicated in oxaluria and phosphuria, in 
fact in all cases, where taste is foul or flabby, denoting 
impaired digestion. If there are sour eructations, flat- 
ulency, etc., whether the urine be alkaline or not, 
alkalies in small doses (p. 53). Chloral (p. 29) as hyp- 
notic; and in oxalic and phosphatic cases, Conium or 
Bell. suppositories (375), to allay local irritation; or Co- 
caine (see Neuralgia). Of other remedies may be men- 
tioned, for lithiasis, Lithium and Arctostaphylum (pp. 51 
& 6S); for phosphuria, Acid. sulf. (pp. 61 & 72); for oxa- 
luria, Ferrum (pp. 79-81); Quinine (p. 76); Zinc and 
Strychnos (pp. 83 & 86). 

Urticaria. See Skin. 

Uterus — In the majority of cases, a diseased uterus, 
which has been for a long time in an abnormal condi- 
tion, will be found enlarged and displaced; there will 
be most likely catarrh of the lining membrane, a granu- 
lar condition of cervix; and probably, slightly enlarged 
and sensitive ovaries. A proper examination (p. 126) 



410 Uterus. 

of the womb has to be made, whenever existing symp- 
toms of a female disease cannot be explained otherwise. 
Disjolacements — In anteversion, there are sometimes 
no symptoms whatever; generally, however, the pres- 
sure of the os against the posterior vaginal wall will in- 
duce dysmenorrhea and sterility; whilst the pressure of 
the fundus against the bladder and the cervix against 
the rectum will cause there irritation. In the former 
there will be a state, bordering upon cystitis; and in the 
latter, tenesmus and pain; besides neuralgia in con- 
sequence of compression of the nerves, and more or less 
difficulty in locomotion. Anteversion is generally com- 
bined with flexion, and if it is complete, the uterus will 
be found lying at an angle of 90° to the normal — the 
axis being taken to be a line passing from the umbilicus 
to the point of os coccygis; if partial, the angle may not 
exceed 45°. Treatment — The patient should be placed 
upon her back on a table, after having previously emp- 
tied the bladder by a catheter and removed all tight 
clothing from the abdomen. Then two fingers, well 
oiled, should be passed into the vagina so as to reach 
with their tips the body of the uterus, which will have 
forced the walls of the bladder down before it, and the 
patient directed to take a deep breath. Now, while the 
latter expels the air gently by a prolonged expiration, 
the operator presses up the body of the uterus with the 
fingers in the vagina, and the abdominal viscera and 
fundus with the other hand on the abdomen. After the 
fundus is lifted, the hand on the abdomen must keep it 
up until the cervix has been pulled forward towards the 
symphysis with the fingers in the vagina. The reten- 
tion of the uterus in position is generally effected by an 



D isplacements . 411 

internal pessary; but if we have no skill in its use, it is 
better to employ one with a stem arching over the 
perineum, or going over the symphysis and anterior ab- 
dominal walls. A still safer plan for the inexperienced 
is to merely lift the displaced organ without rectifying 
the anterior displacement and keeping it in that posi- 
tion by the ordinary ring- or GarieVs air pessary in 
conjunction with the abdominal pad of wood or cork. 

Retroversion sometimes gives neither rise to any 
symptoms, though a fixed, gnawing pain in the back, 
discomfort in walking, and pain in defecation with te- 
nesmus of rectum and bladder are common. Very se- 
vere symptoms are sure to follow sudden retroversion, 
the result of succussion: The patient falls to the ground, 
and is unable to rise, suffers from suppression of urine 
and feces; and is often in such agony that the face is 
bathed with perspiration, and the pulse becomes weak 
and fluttering. Like anteversion, it may produce con- 
gestion, areolar hyperplasia, dysmenorrhoea, sterility, 
etc; and the pressure of the fundus on the sacral plexus 
causes at times complete paraplegia. Retroversion has 
three degrees: The uterine axis lying to that of the 
superior straight at an angle of 45°; 90°, (thus lying 
across the pelvis); and 138°, the cervix being thrown up, 
and the fundus descending. Treatment — Standing at 
the back of the patient, who is placed in Sim's position 
(p. 127), we introduce index and middle finger of the 
right hand to the fundus, their palmar surfaces being 
directed to the rectum: The uterus is now lifted upon 
the inner surface of the fingers, until it becomes erect, 
then their dorsal surfaces (the back of the nails) are 
made to push the organ over into the normal position. 



412 Uterus. 

Or a sponge, fixed in a sponge-holder may be introduc- 
ed and pressed into \he fornix vagince — this latter pro- 
cedure may be made still more effective by carrying an- 
other sponge-staff up the rectum. If it can't be reduc- 
ed in this way, the patient is made to kneel upon a table, 
with the chest resting on it. Two fingers of the right 
hand are now carried against the fundus, elevating it 
forcibly, whilst the patient, after having taken a deep 
breath makes a profound expiration. Should this plan 
fail too, the buttocks should be still more raised by 
placing cushions under the knees, and the attempt re- 
peated with two fingers in the rectum. In cases, requir- 
ing no particular force, Sim's repositor may be employ- 
ed, or, if not handy, the uterine sound: Having intro- 
duced it, the handle should be held with the left hand, 
and while the tips of the fingers of the other hand press 
upon the staff near its middle, thus making of the sound 
a lever; it must be pushed back gently to the perineum. 
This movement will lift the uterus and partially restore 
it. Now the tip of the sound is made to revolve very 
gently, and the uterus carried into a condition of ante- 
version. For its retention in situ a tampon of carbol- 
ized cotton, or a sponge, saturated with carbo/ized gly- 
cerine, either of the size of a small hen's egg, may be 
carefully pushed as far as possible into the fornix va- 
gince, the uterus being held in a state of complete an- 
teversion by means of a repositor or sound. Then 
the sound being removed, a large roll of aseptic cotton 
should be placed below the cervix and a little anterior 
to it, so as to lift this part up into the hollow of the sa- 
crum against the roll in the fornix. The tampon (369) 
may be retained for 48 hours without inconvenience. Af- 



Displacements. 413 

terwards, when a pessary is employed, care should be 
taken, that it create no discomfort, as in such a case a 
most violent cellulitis may result. In f act, p essa ries 
should be always controlled, as besides cellulitis or peri- 
tonitis they may produce not only vesico, recto and 
utero-vaginal fistulas, but even pass out of the vagina 
into the rectum or bladder. While a pessary is kept 
in the vagina, daily vaginal injections should be made 
(358 et seq.). 

Flexion is quite frequent, in slight degrees, in nulli- 
parous women, without constituting a disease; during 
childhood it is even the rule. As at the point of any 
flexion the cervical canal is always more or less closed, 
the ingress of fluids is prevented, and sterility com- 
monly results; at the same time is the egress so much 
interfered with, as to produce dysmenorrhoea, haemato- 
metra, hydrometra, and accumulations of mucus, which 
latter again results in endometritis, and even hemato- 
cele by regurgitation. A consequence of venous hyper- 
emia, arising from hindered reflux of blood at the point 
of flexion is oedema with tumefaction and genuine hy- 
pertrophy of the body of the uterus. In fact, neck and 
body will become tumid, tender and painful, the mucous 
lining so congested as to secrete excessive amounts of 
mucus and blood; and the tissues of the organ, excited to 
excessive growth by prolonged blood stasis, undergo in 
time marked hypergenesis. Besides these consequen- 
ces there may be a tendency to abortion, menorrhagia, 
ovaritis and salpingitis, granular degeneration, uterine 
neuralgia, pelvic peritonitis, cystitis and rectitis. With 
regard to Anteflexion , a certain degree of it may exist for 
years, without the development of symptoms. Sooner 



414 Titer us. 

or later there will be, however, pain over the hypogas- 
trium, in groins and back, increased by locomotion and 
sexual intercourse; with irritable bladder, leucorrhoea, 
dysmenorrhoea, neuralgia, and all kinds of nervous dis- 
turbances. In Retroflexion there will be in addition, 
severe backache, weight in the rectum with tenesmus; 
uterine colic or tenesmus, and gastric disorders. 

Treatment of reducible flexion — body bent forward, 
axis of neck normal. The bowels having been evacuat- 
ed, pelvic and vaginal irritation removed by warm in- 
jections and rest in the dorsal decubitus, the uterus 
sound is introduced to the fundus as straight as it can 
be made to pass, and then the handle, being held in one 
hand, is carried to the symphysis, whilst the tips of the 
fingers of the other are pressed against the shaft of the 
sound near the middle, so as to make a fulcrum, by 
which manoeuvre the flexed uterus is elevated and brought 
towards the hollow of the sacrum. Now the sound' 
should be very gently rotated so as to complete retro- 
version with partial retroflexion. The patient should 
remain in bed for a few days, Cutter's pessary (modi- 
fied) may be applied, and the abdomen pressed inwards 
by means of an ordinary obstetric bandage with a fold- 
ed towel under it as a compress. In case of pain the 
bulb of the pessary should be replaced by a soft sponge, 
which is however to be removed every 24 hours. In 
Flexion with neck bent forward, the axis of body being 
normal, the sound, slightly bent forward, should be car- 
ried to the fundus, and the body thrown backwards, 
where it must be held for several minutes, in order to 
straighten the uterine canal. Now Hurd^s pessary, 
which must exactly fit and fill the vagina, may be in- 



Displacements. 415 

troduced to keep the cervix backward; care being taken 
that it does not get incarcerated, which will sometimes 
happen, especially if the pessary is too small. After- 
wards Meig's ring should be worn for some time, to pre- 
vent the upward and forward pressure of the vagina. As 
in any form of flexion there is generally more or less con- 
traction of the cervical canal, it is well to finish the cure 
by dilating it with graduated sounds. Irreducible flexions , 
which mostly are congenital and one wall of the uterus 
well developed by excessive growth whilst the other is 
atrophied, may be corrected with the intra-uterine stem, 
provided the patient can bear it; or the knife. Before 
the introduction of the stem, the cervix, if found to be 
too contracted, should be dilated by one or more sea- 
tangle tents (p. 130), which for the time will straighten 
the uterus and dilate the canal. After introduction the 
patient should be kept in bed for several days, and upon 
leaving it, should be very careful in her movements for 
some time. Daring menstruation the instrument must 
be removed; likewise when there is pain, chilliness or 
feeling of general languor and discomfort. 

In Retroflexion the patient is placed on her left side, 
with the left hand drawn behind the body. The oper- 
ator stands now behind her, his face looking towards 
her occiput, and the line of the anterior surface of his 
body being about on a level with one passing through 
the patients body at the base of the sacrum. He now 
passes two fingers of his right hand, after having lubri- 
cated them, with their palmar surfaces towards the pos- 
terior wall of the vagina up to the fundus. Then, bend- 
ing forwards, he, by the tips of his fingers, pushes the 
fundus upwards, while, by their bases he retracts the 



416 Uterus. 

perineum, elevates the posterior vaginal wall, and ad- 
mits air freely to the vagina. If this method should fail, 
the knee-chest position may be tried. Should the sound 
be used, it must be introduced but slightly bent to the 
uterus: Holding the handle in the left, the tips of the 
fingers of the other hand should be placed on the shaft 
to carry it towards the perineum as far as possible. The 
uterus being now to a certain degree straightened and 
elevated, the sound should be rotated so as to throw the 
fundus forward, at the same time the handle of the in- 
strument held in one hand has to be carried towards 
the patient's back, so as to advance the tip as far as 
possible towards the abdominal wall. For its reten- 
tion, any pessary will be of use, provided the fundus be 
light and easily reducible; but if it be heavy or rebell- 
ious, Cutter's will be preferable — the stem pessary will 
only be indicated, if the vagina unites so low to the cer- 
vix as not to leave a post-cervical space. If there be 
much tenderness, a sponge or the inflated soft rubber 
pessary may be advisable; or still better the fornix may 
be packed with medicated cotton or sponge to elevate 
the whole uterus as in retroversion. 

Irreducible flexions, Awe to old false membranous at- 
tachments are better left alone, unless the patient is 
very much suffering from the displacement, as in treat- 
ing it, we always incur the risk of peritonitis. In case 
the flexion be due to parenchymatous alteration, all that 
can be done, is 'to bend the body cautiously forward 
once or twice a week, by means of the sound or reposi- 
tor and then keep it in anterior inclination with a retro- 
flexion pessary or Cutter's modification. Sometimes 
the fornix should be filled with a soft moist sponge and 



Displacements. 417 

the body sustained by a tampon of cotton in the vagina. 
In these cases the patient should be kept very quiet, 
and all pain should be soothed by the free use of Opium 
to prevent peritonitis. 

Latere flexion of the uterus, which is either a conse- 
quence of disease of its proper tissue or of direct pres- 
sure, requires generally the intra -uterine stem. 

Proleqjsus Uteri may even in the third degree remain 
without marked symptoms; but generally congestion, 
areolar hyperplasia and granular degeneration occur, 
which render it sensitive and intolerant of pressure or 
friction. In the first degree, the fingers passed up the 
vagina, will meet the os low down in the pelvis, yiressing 
upon the floor; in the second degree — the patient being 
examined standing — the os will be found at the ostium 
vagince, prevented from extruding only by the resist- 
ance of the sphincter muscles. As congestion and hy- 
perplasia affect not only the parenchyma of the uterus, 
but also the mucous membrane and submucous tissue, 
endometritis is invariably a consequence of prolapsus. 
The vagina, which as the uterus descends is inverted, 
makes constant traction upon the os externum by its cer- 
vical attachment, until the canal becomes completely 
everted, turning the os internum literally into the exter- 
nal and only os uteri, the real os externum having disap- 
peared by expansion. Dislocation of the bladder, which 
by uterine descent may happen to such extent, that, if 
a catheter be introduced, it will pass downwards and 
backwards, is also a grave complication, since traction 
and dislocation not only tend to the production of cys- 
titis, but this is further induced by reflex irritation 
and by decomposition of urine, retained in the pocket, 



418 Uterus. 

formed by the inverted wall of the bladder. By a 
similar process prolapse of the anterior wall of the rec- 
tum occurs, and results in fecal impaction at this point. 
Sudden or acute falling of the womb may come on 
from any great effort, a fall, or violent contraction of 
the abdominal muscles, acting upon a womb which is en- 
larged by hyperplasia, subinvolution, pregnancy or tu- 
mor. It may even occur to a uterus normal in size and 
constituency: In an instant the patient feels that some- 
thing has given way within her, becomes prostrate and 
much alarmed, suffering pain of an expulsive charac- 
ter. Should in these cases reduction not be effected at 
once, violent pain will be felt over the sacrum and 
groins and the degree of traction exerted upon the pel- 
vic peritoneum may result in dangerous inflammation. 
Treatment — The patient, after thorough evacuation of 
the rectum and bladder, if this be possible, should be 
placed upon her knees and chest, in order to cause grav- 
itation of the pelvic and abdominal viscera towards the 
diaphragm. She should kneel upon the floor or a table 
and ten or fifteen minutes should be allowed to elapse 
before any efforts are made at reduction, in which time 
the existing congestion of the viscera will greatly di- 
minish. The operator then taking the cervix into the 
grasp of his index, middle and ring-fingers, pushes the 
uterus firmly upwards in coincidence with the axis of 
the inferior strait, steadying at the same time the pa- 
tient by placing the left hand upon her back. The pres- 
sure has to be kept up for fifteen minutes and longer 
until the uterus is restored to its place. It remains now 
to adopt proper measures in order to sustain the organ 
in situ, which, as a rule, is no easy matter. If for in- 



Displacements. 4 1 

stance, the prolapse is associated with subinvolution, 
prolapse of the vagina, and rupture of the perineum, a 
most frequent combination, the three factors — increased 
weight, feeble supports^ and traction — have to be taken 
into account. To prevent pressure from above, it will 
be imperative to avoid the accumulation of urine or fe- 
ces, and to shun tight clothing; the use of skirt-support- 
ers will be of more or less advantage. Means for di- 
minishing the uterine weight are, treatment of inflam- 
mation, hypertrophy or congestion; removal of growths 
and perhaps amputation of the cervix. Means for 
strengthening or supplementing uterine supports are, 
aside from douches, cold hip baths, and recumbent pos- 
ture, local astringents — Tannin, Alum or Iron (359-61) 
in conjunction with an invigorating diet, sea bathing 
and general tonics — Ergot, Ferrum, Strichnos (pp. 78- 
83); and a pessary , provided a morbid condition of the 
part does not forbid its use. Sometimes an india-rubber 
ball is preferable, as it is soft and unresisting. Care, 
however should be taken, that the air is squeezed 
out, and that the hole is looking towards the vulva, so 
that it may again become distended, as soon as it is prop- 
erly lodged in the vagina. Moreover a string should 
be attached to it, that the patient may be able to re- 
move it daily to have it cleaned. If the uterus thus 
has been fixed, a cold hip-bath and morning and night 
an injection of cold water or Alum and Zinc in connec- 
tion with a cathartic — Rheum cum Aloes (197 & 216) will 
do a great deal of good. Before resorting to a pessary 
the patient should be kept in the recumbent posture for 
a few days with the feet of the bedstead elevated about 
six inches, for the purpose of allowing congestion to 



420 Uterus. 

pass off. At the same time mild cathartics (p. 91) to 
remove fecal matter and stimulate circulation, may be 
given with astringent vagina/ injections to harden the 
tissues for the reception of the pessary, and to cause 
contraction of the distended superficial blood vessels of 
the vagina. If the weight of the uterus be but moder- 
ate, an internal pessary will do— Meig's elastic ring, 
Hodge's, Smith's, etc. — provided it does not distend the 
vagina, and can be worn without discomfort. It should 
however be kept clean by irrigation with an astringeut 
at least once a day, and should be examined from time 
to time, to make sure that it is not cutting into the tis- 
sue. If the uterus be too heavy or the prolapse of the 
3d degree (procidentia, uteri), Cutter's pessary with a 
stem curbing over the perineum, will be preferable. 
The cup at its extremity receives the cervix, and the in- 
strument can easily be removed at night, and replaced 
in the morning by the patient herself. As regards the 
means for preventing traction by the vagina, partial re- 
lief may sometimes be obtained by applying to the weak 
part a pad or cushion filled with cotton, hair, or air, com- 
bined with an abdominal supporter, to which it may be 
attached. In Procidentia, especially during pregnancy, 
a soft compress with a T bandage, for the support, to- 
gether with a mild aperient to keep up a soluble state of 
the bowels. The proper remedy is, of course, the res- 
toration of the perineal body (perineorrhaphy), and the 
narrowing of the vagina (elytrorrhaphy). 

Simple Prolapse may sometimes be cured in from six 
to eight weeks, by the daily performance of a process of 
massage and uterine elevation in conjunction with cer- 
tain gymnastics. The elevation of the uterus cannot be 



Displacements. 48 1 

carried out without the aid of an assistant, who, with 
one hand, has to push up the uterus in the vagina, keep- 
ing it in a state of anteflexion, while he puts his other 
hand on the abdomen, exactly over the uterus. The 
operator, standing at the foot of the table, on which 
the patient is lying, lays now his two hands, strongly 
supinated, flat on the abdomen, the fingers being point- 
ed towards the pubes, and grasping the fundus between 
them, raises the uterus gently but steadily upwards, in the 
pelvic axis. When the organ has been elevated as far 
as is possible (which may be as much over its normal 
level, as it had been prolapsed), it is allowed to slip 
from between the hands, and sink slowly until its de- 
scent is arrested by the assistant's finger, which has re- 
mained in the vagina to fix, and keep it in a condition of 
anteflexion. This movement of elevation is repeated 
two or three times at each sitting, a few minutes inter- 
val being allowed between each, during which time the 
assistant massages the fundus in order to stimulate it to 
contract. To carry out the second or gymnastic move- 
ment, the patient should be placed in the exaggerated 
stone position, and closing the knees and thighs, she 
should elevate the sacrum, so that the body rests on the 
elbows and feet only. In this position, the operator 
forcibly separates the knees, whilst the patient resists 
him as much as possible. Having repeated this proced- 
ure about three times, a contrary movement -the pa- 
tient lying with the knees widely separated, and the oper- 
ator bringing them forcibly together — is now practiced 
for as many times; when the patient should turn over 
on the face and remain in that position for about ten 
minutes, which closes the sitting. 



422 Uterus. 

Inversion is generally a cause of mismanagement in 
the removal of the placenta after childbirth. The uterus 
should be fixed with one hand near the symphysis pubis, 
whilst the tips of the fingers of the other hand are plac- 
ed in the middle of the projecting part and pushed up- 
wards, indenting the uterus until the point has passed 
through the os, when it will get into its place as easy as 
possible. When the uterus is again right, the hand 
must not be retracted too suddenly, as it might invert 
again. The bowels should be kept in a soluble state by 
salines (218). 

Uterine Colic. See Menstruation and Ovaries. 

Uterine irritation is mostly a consequence of de- 
fective menstruation, and liable to produce a host of 
nervous disorders — neuralgia, convulsions, paralysis, 
even epilepsy. At each menstrual crisis the peripheral 
extremities of the spinal nerves, which are distributed 
on the cervix uteri, as well as the extremities of the sym- 
pathetic, which pass to the upper portion of the womb, 
being subjected to unusal irritation, this irritation may 
be transmitted directly by the spinal nerves, and indi- 
rectly by the sympathetic filaments to the brain and 
spinal marrow. Treatment is directed to the causative 
disease — Potassa (p. 54); Brom (p. 26); Morphia (255); 
Arsenic (p. 10); Argentum (p. 74); etc. Locally suppos- 
itories of Iodoform or Belladonna (374 & 75). 

Endometritis acuta is characterized by a swollen 
and very sensitive cervix; a discharge clear and albu- 
minous-looking, or consisting of long tenacious shreds 
of cervical mucus, which comes from the gaping os 
uteri; accompanied by pain in the back, and groins; 
burning in the vagina, which sometimes is very dry and 



Inflammations. 423 

hot; and vesical and rectal tenesmus. Occasionally there 
is tympanites or diarrhoea, due to reflex irritation of the 
rectal nerves. It is caused by direct injury; cold from 
exposure during menstruation or stoppage of same; ex- 
cessive venery; etc., etc.; and may be complicated with 
vaginitis, cystitis, pruritus vulvae and various eruptive 
disorders. When occurring in the non-puerperal state, 
it may without treatment go on to recovery; some- 
times it will eventuate in the chronic form of mucous 
inflammation, or in a slight hyperplasia; but if the in- 
flammation should extend, it may even prove fatal. 
Treatment — Complete rest; a warm linseed poultice cov- 
ered with oiled silk, over the hypogastrium; and for the 
relief of pain, Opium (p. 37). No cathartics unless con- 
stipation. As soon as the discharge becomes more co- 
pious, emollient injections (358) three times a day. 

Chronic Cervical Endometritis — Cervical Leucorrhoea 
is characterized by a glairy mucus, discharged by the 
glands of Naboth, which are especially involved in the 
morbid action, producing soon abrasion round the os. 
The hypertrophy, which by degrees develops in the 
villi, is called granular degeneration. The usual symp- 
toms are, dragging sensations about the pelvis, pain in 
back and loins and menstrual aberration. Sooner or la- 
ter nervousness will supervene and sometimes a disor- 
dered digestion, coupled with nausea and even vomit- 
ing. Occasionally the disease is complicated with an ever- 
sion of the os and lower portion of the canal to such an 
extent as to keep up inflammation there by the friction 
of the membrane thus exposed, against the floor of the 
pelvis. Other complications are a very troublesome va- 
ginitis, cystitis and a cervical hyperplasia, which will 



424 Uterus. 

produce great pain during coition. Of the many causes, 
which give rise to this disease, may be named artificial 
abortion, excessive coition, vaginitis, obstructive dys- 
menorrhea, laceration of cervix, polypi, displacements, 
and pessaries. Though an alterative influence, which ex- 
erts a complete change in the economy, as parturition, a 
change of habits, and the like, may result in a cure, the 
disease is usually very obstinate — the mildest case last- 
ing about six months under the best treatment; and in 
multiparous women it generally passes into cervical hy- 
perplasia with its train of ailments, which will cause a 
•life of misery. Treatment — Saline cathartics combin- 
ed with tonics — Magnesia (219), to keep the bowels 
in a soluble state; Acid, nitro-mur. (p. 11) in enfeebled 
digestion; &n&Brom (p. 25 et seq.), if much nervousness; 
with emollient injections (358) twice a day as in endo- 
metritis. If the os be contracted, it must be above all 
dilated, which is best done by snipping the external 
fibres of the os with scissors for one-fourth of an inch, 
touching the raw surfaces with caustic, to prevent union, 
and keeping a plug of greased lint or cotton in the ca- 
nal for a week; or a tent (p. 130) or sponge may be used, 
as they, to a certain extent, are also free from danger, 
as long as they do not penetrate the os internum. After 
dilatation the mucus may be removed in the following 
manner: After having slipped upon the extremity of a 
long-piped hard-rubber syringe (of 1 oz. capacity), which 
can be worked with one hand, a bit of gutta-percha 
tubing, the free portion of which projects half an inch, 
it is introduced as far as the os internum, when the pis- 
ton is powerfully retracted. If the matter is purulent 
or starchy and not tenacious, a stream of water may be 



Inflammations. 425 

projected from this syringe against the cervix, and the 
whole removed by suction; or this may be done by a 
small pledget of cotton, wrapped round a probe. The 
latter instrument will also answer for the application of 
the remedial agent to the canal — a strong solution of 
Zinc, Salicin or Iodine (343, 348, 354 & 55). A very 
good plan is to rub a probe, coated with caustic, against 
every part of the investing membrane, and dipping it 
carefully in its convolutions. After the application a 
stream of water should be projected against the cervix, 
after which some cotton saturated in Glycerine (369) 
may be placed over it. The cotton has to be removed 
in twelve hours (by means of a thread which has been 
attached to it for that purpose). Or the probe with the 
cotton, which has been soaked in the solution selected 
— zinc, copper, iron, lead or bismuth with opium, con- 
iura, or hyoscyamus, etc., etc. — is passed into the cervi- 
cal canal so as to engage within the os internum, when 
the cotton may be slid off by means of the slide and 
left within the canal. After twelve hours it has to be 
removed. 

In cases where a glairy and very tenacious plug of 
mucus is hanging from the os, the glands must be de- 
stroyed with Acid, nitric, fumans or chromicum (344). 
This has to be followed, like the other applications by 
an injection of water and a wad of cotton. In ten days 
or a fortnight a slough of the cervical mucosa will take 
place, after which the surface should be painted over 
twice a week with Argenti Nitras. If these means 
should prove ineffectual, the glands must be removed 
by Sini's curette. 

Chronic Corporeal Endometritis {Uterine Catarrh or 



426 Uterus. 

Uterine Leucorrhced) — Internal Metritis lasts generally 
for years; and though it may confine itself to the mucous 
membrane, as arule it will gradually excite congestion and 
exuberant growth in the adjacentparenchyma — hyperpla- 
sia; sometimes a want of nutrition may take place, event- 
uating in distention. Barring the pain in the back, groins 
and hypogastrium, there is often tympanites, symptoms 
of pregnancy and nervous disorders — especially neural- 
gia confined to the crown of the head. The most prom- 
inent symptom however is a profuse leucorrhcea more or 
less tinged with blood, particularly for some time after 
menstruation, which latter is also faulty — either pro- 
fuse or too scanty. The most frequent complications are: 
Displacement, granular degeneration of cervix, vaginitis 
and pruritus vulvse. Treatment is similar to that of cervi- 
cal endometritis: Improvement of general health and lo- 
cal applications — Chrom, Zinc, Ferrum (344 & 48); and 
hot douches. Internally, Strychnos (172), but without 
Ferrum, if menorrhagia; and other tonics. As regards 
intra-uterine injections, they should never be made with- 
out securing an immediate reflux (by a double-canula sy- 
ringe), the os internum must be properly dilated, or a 
tent (p. 130) must be previously used. In fact, injections 
should never be used in a sharply flexed uterus before 
replacement, never just before or after a menstrual pe- 
riod; and never when pelvic peritonitis or periuterine 
cellulitis has recently existed. At the same time care 
should be taken never to inject with force, and to allow 
no air in the syringe. It is best to begin always with a 
weak alkaline injection of warm water (not below 85°) 
to test the tolerance of the uterus; and the organ should 
always be washed out before a stronger solution is used, 



Hyperplasia. ±21 

which should be of the same temperature. The patient 
has then to lie down until all sense of discomfort has 
passed; if however there should be uterine colic or pain 
of some sort, Opium must be given freely. Intra-uterine 
scarification is another way of assisting the cure; but 
if there are fungoid granulations, mucous cysts or po- 
lypi, the little copper curette is preferable. 

Areolar Hyperplasia of the Uterus — Chronic paren- 
chymatous Metritis is no inflammatory process, but con- 
sists of a proliferation or hypertrophy of the areolar or 
connective tissue of the uterus, accompanied by con- 
gestion and nervous hyperesthesia. It is, as a rule, a 
consequence of subinvolution; but it may result from 
displacements, cervical endometritis, or sexual inter- 
course; from the latter, when excessively indulged in, 
shortly before or after the menstrual period, as the 
uterus, being an erectile organ, is subject to active phys- 
iological congestion. Sometimes cardiac diseases and 
abdominal tumors, which produce blood stasis and 
oedema in the feet, the labia majora and the parts about 
the vagina, will affect the uterus in the same way. Cer- 
vical Hyperplasia is characterized by a swollen and pain- 
ful cervix, which may be as large as a small orange and 
fill the vagina, compressing the rectum to such an ex- 
tent, as to interfere with its functions. On account of 
the displacement caused by the great weight, the con- 
gestion is still increased, and the patient suffers, until 
the menopause at least from endometritis, granulation 
and the ordinary symptoms of displacement — some- 
times however atrophy will take place. If the affection 
be general or corporeal, the symptoms attendant on the 
mentioned diseases are still of a graver nature: A dull, 



428 Uterus. 

heavy, dragging pain through the pelvis, much increased 
by walking; pain in defecation and coitus, before and 
during menstruation; pressure on rectum with tenesmus 
and hemorrhoids; on bladder with vesical tenesmus; 
nausea and vomiting; darkening of the areolae of the 
breasts; great nervous disturbance and sterility. Neo- 
plasms and periuterine inflammation may be confounded 
with corporeal hyperplasia in its first stage; the latter 
however will fix the uterus, create hardness and swell- 
ings in the iliac fossae and pouch of Douglas; whilst in 
fibrous growth, conjoined manipulation and the sound 
will assist in the diagnosis. Internal metritis may be 
also suspected in comparative young women, though all 
the signs of early pregnancy are present, provided men- 
struation is not suspended. The second stage of areolar 
hyperplasia or sclerosis might be confounded with scir- 
rhus; but there is no cachexia, nor tendency to hemor- 
rhage; and a sponge-tent will soften the tissue and not 
leave the cervix hard. Treatment must be first directed 
towards the complications, which usually accompany 
hyperplasia (the more so, as in most cases nothing be- 
yond can be done) — displacements, fungoid growths, 
granular degeneration, laceration of cervix, and vagini- 
tis. Prolapse will be benefited, by means of Meig's pes- 
sary; retroversion by Hodge's double lever or one of its 
varieties. Fungoid growths, this source of congestion, 
metrorrhagia and leucorrhoea must be removed by gent- 
ly scraping the whole cavity with the wire-loop curette] 
and laceration of cervix, which aside from congestion, 
causes not only neuralgia but intense nervous irritation, 
both, immediate and reflex, and which is frequently over- 
looked, especially if the excoriated walls of the cervix 



Hyperplasia. 429 

have been treated for some time by caustics, should be 
repaired by fixing in the parts of the severed lips tena- 
cula and then to approximate them as accurately as pos- 
sible. Before the suture is applied^ their inner surf toes 
have to be, of course, thoroughly pared. The complica- 
tions being removed, there remains a large, heavy uterus, 
the tissue of which is exuberant, the blood vessels en- 
larged and the nerves in a condition of hyperesthesia. 
This state requires, barring general treatment with rest, 
great discrimination with regard to local applications. 
If the uterus is very tender a few ounces of blood may 
be taken occasionally by puncture or scarification: A 
sharp and narrow bistoury or tenotomy knife is passed 
up to the os internum, and cutting through the mucous 
membrane and the superficial layer of muscular tissue, 
it is withdrawn through the external os. In cases of 
amenorrhoea, three or four leeches may be applied 
through a speculum of sufficient size to contain the en- 
tire vaginal portion of the cervix, after the latter hav- 
ing been thoroughly cleansed and the os been plugged 
with a pledget of cotton, to which is attached a thread 
for removal. Now a few punctures should be made in- 
to the cervix, the leeches thrown in and the speculum 
filled with some cotton, pushed towards the bleeding 
surface. When they have ceased sucking, all clots of 
blood should be removed by a sponge or some cotton, 
and after the withdrawal of the speculum, a large 
sponge, squeezed out of warm water, should be placed 
over the vulva. After this, in fact, after any kind of lo- 
cal depletion, the patient should be kept for some hours 
perfectly quiet. Once a week an alterative — Tinct. Jodi 
comp. or Iodoform (346)^ may be applied by means of a 



430 Uterus. 

brush of pig's bristles to the os internum; or even to 
the fundus, should endometritis exist, and over the 
whole cervix, to be repeated as soon as it has dried, and 
then covered with a tampon (369), Should the hyper- 
aemiabe persistent,counter irritants — vesicating collodion, 
prepared with Acidum aceticum may be applied by 
means of a camel's hair brush to the whole vaginal cer- 
vix and os, followed a few minutes after by a stream of 
cold water, projected upon it to prevent any escape into 
the vagina. Afterwards the Glycerine-tampon should 
be applied for its hydragogue effect, whilst the patient 
is kept perfectly quiet for several days. The vagina 
must be cleansed with warm injections, and as soon as 
the discharge shows a tendency to cease, the blistering 
may be repeated. Vesication may be also produced by ap- 
plying Argentum nitricum, which after having destroyed 
the epithelial covering and sloughed off, leaves a gran- 
ulating surface, that may be dressed with glycerine or 
any of the alteratives. If injections (358) are used, 
they may be put in a tub, across which there is a board 
for the patient to sit on. Instead of Davidson's syringe, 
a fountain syringe is often preferable, as the patient 
may then lie on a lounge, with the buttocks projecting 
over its edge and the feet supported upon the floor, 
without tiring herself with the working of the instru- 
ment. If the cervix should be too bulky, a, part of its 
vaginal portion may be removed by encircling it with 
the galvano -caustic wire. As regards the general treat- 
ment, ferruginous and vegetable tonics — Potassa, Acid, 
sulf. (155 & 173-177) in case of spanaemia; and altera- 
tives to the bowels in conjunction with a nourishing 
diet may be tried. During the stage of enlargement 



Degeneration. 431 

(before contraction of the exuberant tissue has occurred), 
Ergot (p. (So) will be of value, if kept up for some time. 

Chronic (soft) Engorgement from passive congestion 
with loss of tonicity in the blood vessels, which is always 
accompanied by profuse menstruation, and not uncom- 
mon in the climacteric period, requires cold injections into 
the rectum (about 8 oz.); internally Tinct. Ergotce ( 3 j 
bis die), and regulation of bowels. Sometimes Ruta or 
Borax (pp. 3S & 55) will answer very well — In chronic 
engorgement with amenorrhoea, a dozen of leeches ap- 
plied to vulva, and the bleeding to be promoted by fo- 
mentations, with Calomel (p. 92) at night, if necessary 
or salines (p. 96) as circumstances may indicate; and the 
whole procedure to be repeated at the time of the ex- 
pected menses, when there is much bearing-down pain. 
In induration or hard engorgement, revulsive bleedings 
from the arm every fortnight with saline aperients, or 
slight scarifications twice a week, if necessary; but the 
best remedy perhaps is Hydrargyrum jodatum flavum (12) 
if not contra-indicated by the general state of health. 

Granular Degeneration of Cervix presents various 
forms: In abrasion the epithelial covering is removed 
and the villi are destroyed; if the papillae increase in 
size and project like granulations, the looped capillaries, 
which they contain, become also hypertrophic and va- 
ricose and naturally bleed easily, constituting the vari- 
cose idcer. If the surface becomes coated with a false 
membrane, it is called the diphtheric ulcer. E version 
of the cervix with increase of the villous hypertrophy 
in the crested folds of the everted membrane represents 
the fungous ulcer or coxcomb granulation. The light 
forms may produce no symptoms whatever; however 



432 Uterus. 

the severer ones will be characterized by more or less 
pain in back and loins; leucorrhcea, profuse menstrua- 
tion; sometimes hemorrhage after intercourse; tendency 
to anaemia; nervous disorders and perhaps hysteria. Bar- 
ring diseases which keep the villi of the cervix con- 
stantly bathed in an ichorous fluid, cervical degenera- 
tion will be caused by any influence producing conges- 
tion of the uterus, or anything, which keeps up friction 
against the cervix. On the other hand, the affection 
will keep up a hyperemia in the neighboring parts, and 
will even exert a reflex influence on the ovaries. Treat- 
ment — Aside from special attention to the general 
health, copious injections should be made daily — Zinc, 
Alum, Tannin, etc. (359); sometimes suppositories are of 
use (35V). Argenti Nitras (343) with a coating of styptic 
collodion (415) may be applied once a week. (The latter 
does not only protect the part from friction and dis- 
charges, but acts also as a direct alterative, and dimin- 
ishes congestion by compressing the excoriated villi 
with their increased vascularity). Other alteratives are: 
Cuprum, Ferrum, Iodine, Phenol and Chrom (344, 47, 48, 
51 &67). In simple eversion the hemorrhoidal mucous 
membrane must be destroyed by touching it with Acid, 
nitric, fumans (329); or it may be cut off with scissors. 
If it be due to laceration, the edges of the cervical fis- 
sures should be accurately united by deep sutures of sil- 
ver wire, after having pared them with long scissors. 
In coxcomb granulation, the growths must first be snipp- 
ed as close as possible to the mucous membrane with 
a pair of long-handled scissors, or scraped off by means 
of a steel curette, before making the local application. 
If the congestion can not be mastered by means of the 



Subin volution. 433 

various applications, a few superficial incisions in the 
sub mucous tissue of the cervix with a curved bistoury, 
as indicated in hyperplasia, may be tried. Well fitting 
pessaries, supporters, etc., will occasionally be of value. 

Cystic or Follicular Degeneration, called also Acne, Her- 
pes, or Aphthae, of the Uterus, is an inflammation of the 
mucous glands of the vaginal cervix, characterized by a 
number of vesicles of the size of a millet seed, which 
after bursting, leave depressions, where the papillae un- 
dergo hypertrophy and appear like red, elevated tuber- 
cles of the size of a hemp seed. The disease is gener- 
ally secondary to cervical endometritis, hyperplasia and 
granular degeneration. Treatment — The cysts should 
be opened with a bistoury and then thoroughly cauter 
ized with Arg. nitr., Chrom,ov Hydr. nitr. acid, (344). If 
this should be of no avail, the vaginal face of the cer- 
vix must be removed by means of the bistoury, scissors 
or still better by the ga/vano -caustic wire. 

Cystic Degeneration of the Chorion is called the pe- 
culiar metamorphosis of this membrane, which it may 
undergo, when, having remained attached to the uterine 
walls after expulsion or death of the embryo. See 
Hydatids. 

Subinvolution — The uterus is said to be in this state, 
if, after delivery, the retrograde evolution has been 
checked or retarded by certain influences, so that it re- 
mains flabby and large. About the fourth day after 
the birth of a child the muscular fibres of the uterus be- 
gin to undergo fatty degeneration, the fat thus formed, 
is absorbed and the organ usually has required its nor- 
mal size about the eighth week. Subinvolution consti- 
tutes the chief cause of all chronic uterine disorders. 



434 Uterus, 

Treatment — Ergot (p. 65) with or without injections of 
hot water (358); Uva Ursi (151) is sometimes used, and 
Cacao locally (354). See Areolar Hyperplasia. 

Stricture of the Cervical Canal, which is one of the 
causes of dysmenorrhoea and sterility, maybe remedied by 
means of graduated bougies, tents (pp. 129 & 130), or 
expanding instruments; sometimes a superficial incision 
through the whole course of the canal (with a narrow- 
bladed bistoury, if a hysterotome be not at hand) may 
be necessary. A sound should be left in position for 
several minutes, and upon its removal, another may 
be inserted, until the distention deemed practicable 
at one sitting is attained, which ought to be done 
at least ten times at intervals of from 5-7 days. Or a 
small-sized metallic male catheter may be glided on the 
index finger of the left hand previously introduced into 
the vagina. On reaching the os the handle must be de- 
pressed in order to give an upward direction to the 
curved portion of the instrument corresponding to the 
axis of the uterus. After having entered the cervix, a 
few oscillatory movements may be given to the instru- 
ment, and then it may be withdrawn. If very painful, 
Chloral (365). See Dysmenorrhoea. 

Imperforate Os Uteri unless congenital, is the result 
of injury, as injudicious probing the womb, which is 
sometimes done by women in order to abort, and which 
may result in closure of the canal. It will soon cause 
enlargement of the womb from retained menstruation, 
(Haemometra), accompanied with symptoms of pregnan- 
cy, as morning sickness and tumefied breasts, which ha° 
to be borne in mind in cases of young girls whose repu- 
tation is criticized, Diagnostic is the closure, resp. 



Neuralgia. 435 

entire absence of the two lips of the os, instead of which 
there may be found in the middle and lower portion of 
the uterus, corresponding with the os, a slight circular 
depression. Treatment — The index finger of the left 
hand being introduced into the vagina, up to the central 
and lower portion of the cervix, to serve as guide, a 
curved trocar is carried with the other hand and made 
to penetrate the womb from below upwards, parallel to 
the axis of that organ. In order to prevent the closure 
of the cut, a soft bougie must be kept there for a few 
da^s, whilst the patient remains in a recumbent position. 

Ilgdromctra is produced by the accumulation of the 
fluid (secreted as a consequence of chronic endometri- 
tis) due to some obstruction in the cervical canal, and 
occurring frequently in elderly women. Aside from 
the enlargement, there will be from time to time colic 
pains of a bearing-down character. Treatment— Jiz 
moval of the liquid by means of sounds, tents or trocar. 

Physometra signifies the accumulation of gas in the cav- 
ity, easily to be recognized by the tympanitic sound on 
percussion. Treatment — After removal of the gas, Mer- 
cury (p. 12) until ptyalism, followed by Acid, nitric, (p. 9) 
and tonics (p. 61). 

Neuralgia of the uterus is characterized by pain, in- 
creased by sexual intercourse, and accompanied gener- 
ally by a mucous discharge. Sometimes there is a pain 
in the back, sometimes in the lower portion of the ab- 
domen or in the loins, sometimes it is limited to the 
urethra; it may go and come; it maybe periodic; and it 
may be so severe as to make coition impossible — it may 
even produce convulsions or mania. This rheumatism 
of the womb or hysteralgia has an analogon in the 



436 Uterus. 

specific pain of the testicles in the male, and in the neu- 
ralgia of the labia externa in the female; the former be- 
ing propagated through the ileo-scrotal, and the latter 
through the ileo-pudendal nerve from the lumbar region. 
The catarrh is here but the result of a peculiar state of 
the uterine nerves, like the increased secretion of saliva, 
s affected by a savory dish. Treatment — If sympto- 
matic of disease of the womb, this has to be attended 
to; otherwise powerful revulsives to the spine, as a ni- 
tric acid issue on the side of the lumbar vertebrae, with 
cauterization of the os uteri or even an incision of the 
cervix. Ungt. Belladonnce or injections of Opium (381) 
will occasionally relieve. If marked by periodicity, 
Quinine (p. 11). 

Rupture of the womb is accompanied by severe pain 
and a noise like a loud click, and the child will be felt 
high up near the umbilicus. Here is Ccesarian section 
indicated and prompt action necessary: A cut of six 
inches at least should be made, if necessary to the um- 
bilicus, but half an inch on the side of it. After remov- 
al of the child, with placenta, the blood, Liq. Amnii, 
etc., the uterus must be sown up again, as the stitches 
will not hurt in the peritoneal cavity. 

Moles are generally made up by polypoid and fibrous 
growths, blood clots, and the membrane of congestive 
dysmenorrhoea; but sometimes they are connected with 
pregnancy, when they consist of a part or the whole of 
the foetal shell or placenta. As a rule, the whole of the 
products of conception is swept away by uterine cop 
tractions, in case the life of the foetus has been destroy- 
ed by adverse influences; sometimes however the shell 
of membranes will cling to its attachment and become 



Hydatids. 43-, 

to a certain extent organized, to be expelled as an an- 
omalous substance, which resembles the product of con- 
ception at the second month. The condition may be 
suspected, when, aside from uterine enlargement there 
appear menorrhagia or metrorrhagia, hypogastric weight 
and uterine tenesmus with uneasiness; and in cases 
connected with pregnancy, cessation of the signs be- 
longing to that state. Treatment — After having prov- 
ed its existence by microscopical examination of a small 
piece of the mass, removed for that purpose (if necessa- 
ry), the cervix should be fully dilated by tents (p. 130), 
and uterine action caused by the persistent use of Ergot 
(p. 65). Should this fail, the mass must be removed 
with a large uterine scoop, or by traction with the pla- 
cental forceps. 

Hydatids consist of small, oblong sacs, which are pedi- 
culated and distended by a serous fluid, so as to appear 
like a bunch of grapes; and if due to the presence of the 
acephalocyst, very dangerous on account of the hemor- 
rhage, which generally is more profuse than that occur- 
ring at child-birth. See Cystic Degeneration of Chor- 
ion. Aside from the usual signs of pregnancy, as en- 
largement of the womb, nausea and vomiting, which 
are associated with this disease, there are at certain in- 
tervals bearing-down pains, accompanied by a discharge 
of a watery liquid, which constitutes the distinctive fea- 
ture; for, as the hydatids increase in volume, the most 
dependent ones will irritate the neck of the uterus, thus 
causing contraction and their rupture: hence the period- 
ical discharge of water. During the process of expul- 
sion of the hydatid masses, there is generally profuse 
hemorrhage. See the latter for treatment. 



438 Uterus. 

Polypi^ which always give rise to irregularities in the 
menstruation, especially to much loss of blood, vary in 
size from that of a pea to that of a foetal head. In the 
mucous species, which is essentially vascular, there is 
more loss of blood, than in the fibrous type, though the 
hemorrhage is by no means in proportion to the size; on 
the other hand, the menses will invariably be more abun 
dantthan usual, since at that time the mucous membrane, 
which invests the tumor, becomes naturally congested. 
Aside from the hemorrhage there is frequently a mucous 
discharge — a result of the irritation, to which the mucous 
lining is subjected — and bearing-down pains, if its size 
and situation should be such as to cause contractions of 
the uterus. In addition there may be irritable bladder 
and in proportion to the existing anaemia, prostration, 
palpitation of the heart, etc., etc. Treatment — When 
the existence of the growth has been ascertained by 
means of a sound, Ergot (p. 65) should be given, to throw 
it into the vagina, where, guided by the index finger of 
the left hand, its pedicle may be seized with the smaU 
calculus forceps and twisted off. Afterwards vaginal 
injections of cold water twice a day with tonics (p. 76) 
internally. If the finger can be insinuated within the 
uterus, and a stalk be found, the ligature may be applied, 
and the pedicle will slough in about thirty-six hours. 
(If pain, the ligature has, of course, to be loosened again, 
as in that case, the polyp being insensible, the cervix 
would be implicated). If however the parts are very 
much relaxed, and the tumor small, it may be removed 
by torsion with the finger. If a polyp has been excised 
and there is much bleeding, the stump of the pedicle 
may be twisted once or twice by means of forceps. A 



Tumors. 439 

polypus of the mucous species can be brought away but 
by fragments, as it is too soft and has no resistance. The 
removal should be followed by a cold injection daily for 
a few days. See Hemorrhage. 

The fibrous tumor, which develops within the uterus 
or on one of the lips of the os, is covered by mucous 
membrane; if it grows from the external surface of the 
womb, it is covered by peritoneum; and the insterstitial 
has its origin amid the muscular fibres of the organ. 
Whilst the ovarian tumor is situated in one of the iliac fos- 
sa?, the fibroid lies centrally; in the former the os uteri be- 
comes elevated, in the latter it is thrown downwards. 
The whole train of symptoms, indicating gestation, may 
be occasioned by the enlargement of the womb, produc- 
ed by its presence except the peculiar empJnjsematous con- 
dition of the areola of the breast, so characteristic of 
pregnancy — frequent desire to pass water; constipation 
with painful evacuation; swelling and feeling of numb- 
ness in the lower limbs, and suppression of menses. 
There may be hemorrhoids, prolapse of the mucous 
membrane of the rectum, and profuse hemorrhage with 
great emaciation. The bladder will sometimes become 
so much distended, that ureters and kidneys may be in- 
volved, so as to produce coma. Treatment — As the tu- 
mor is occasionally spontaneously absorbed, Iodine (p. 
15) may be tried, with Unguentum mercuriale (353). 
Sometimes it may be expelled hy Ergot (p. 65). If the tu- 
mor projects into the vagina, or is within reach of the fin- 
ger in the cavity of the womb, it may be separated with 
the finger or knife, after having divided the mucous 
membrane. For Cancer of tlie Womb and JB foody Tutn&r 
of the pelvis see Carcinoma, resp. Hematocele. 



440 Uterus. 

Parametritis — Periuterine Cellulitis or Periuterine 
Phlegmon, consists in an inflammation of the adipose 
and areolar tissue of the broad ligaments and of that im- 
mediately in contact with the uterus at its junction with 
the vagina and bladder; and is in severe cases general- 
ly associated with pelvic peritonitis, ovaritis and salpin- 
gitis. Exclusive from parturition and abortion, it may be 
caused by direct injury from coition, caustic applica- 
tions, pessaries, operations or blows; and it may be sec- 
ondary to metritis and ovaritis. Parametritis may re- 
sult in destruction or atrophy of the ovaries, and in a 
permanent displacement of the uterus in consequence of 
strong adhesions,the productof the inflammatory process. 
Cellulitis proper usually passes off in, from two to three 
weeks by resolution; but if suppuration sets in, it w^iil 
ran a most tedious course; and any one of its complica- 
tions may become chronic. In acute cases, following 
parturition, suppuration may take place in a few days; 
though generally it does not occur for two or three 
weeks. The symptoms depend as a rule, on the severi- 
ty of the disease; but though the acute form may show 
all the signs of inflammation, fever, chills and pain, 
combined perhaps with dysuria or metrorrhagia, there are 
cases, marked only by extreme weakness, some sense of 
pulsation with weight about the pelvis, and hectic in the 
evening. In the chronic form, there may be for months 
after delivery general weakness with fever towards 
evening, but without pain; only now and then a throbb- 
ing, especially tension and weight about the organ, 
which is increased by walking, defecation, and urination, 
will remind the mother of her past trouble. At the be- 
ginning of the disease, a very sensitive little swelling may 



Abscess. 441 

be detected on one side of the uterus by conjoined ma- 
nipulation (p. 125), which, as effusion (the second stage) 
advances, and induration occurs in the areolar tissue af- 
fected, will form a tumor as large as a walnut or orange, 
situated in the tissue around the cervix, or in one of the 
broad ligaments. In the third stage the uterus will be 
found more or less displaced in the direction opposite to 
the accumulated pus. (In a chronic case, the effused 
matter may remain hard for months, withont showing 
signs of softening). Treatment — Before effusion, or at 
least before its complete organization, leeches should, in 
the case of a strong patient, be at once applied to the 
hypogastrium, followed by poultices every hour or two. 
Internally Salicin (p. IS), in conjunction with refriger- 
ants and sedatives- Nitre, Aconite, Veratrum or Gelsem- 
ium (pp. 56, 22, 33 & 39). Opium (pp. 37 & 110) through- 
out the acute stage to relieve pain and keep the bowels 
constipated. Afterwards Jod or Brom (pp. 15 & 27), 
and laxatives (p. 88), especially Mercurials (p. 92) to 
keep the bowels in a soluble state and to disgorge the 
veins of the pelvis by acting on the liver. A valuable 
auxiliary will be the warm douche for fifteen minutes 
twice a day, which in the latter part of the disease may 
be slightly medicated with common salt or Tinct. Jodi. 
The treatment of the suppurative stage is indicated in the 
next paragraph. 

Pelvic Abscess unless consisting of tuberculous ma- 
terial, deposited somewhere in the pelvic tissue, is either 
the result of a suppurative action in the walls of a cavi- 
ty formed by an ovarian cyst or hematocele; or, what is 
most frequent, it is an inflammatory suppuration in the 
areolar tissue, the ovaries, tubes, the pelvic peritoneum 



442 Vaccination. 

or the parenchyma of the uterus. The formation of pus 
is characterized by the symptoms of abscess in other 
situations: Chills, followed by fever with profuse per- 
spirations, etc., etc. When left to themselves, these ab- 
scesses may open spontaneously and discharge through 
any part, viscus or foramen, and gradually heal (those, 
which result from puerperal cellulitis, usually discharge 
through the abdominal wall, whilst those, occurring in 
the non-puerperal form, open mostly into the vagina or 
rectum); or they may burrow into the tissue, to open by 
long fistulous tracts into some organ, as the large intes- 
tine or sigmoid flexure, or they may discharge into the 
peritoneum. Treatment — A generous diet, alcohol and 
tonics (p. 72). If it be decided to open the abscess, the 
patient should be placed on the left side, and Sim's specu- 
lum being introduced, the pus be drawn off by aspira- 
tion. If there is any doubt about the nature of the tu- 
mor, it should be previously explored by means of a hy- 
podermic syringe or an exploring needle. Whether the 
vagina, rectum or the abdominal wall be chosen for the 
operation, an anaesthetic to insure perfect quietude, will 
be essential to a safe cure. If the abdominal wall is to 
be opened by trocar or bistoury, adhesion of the layers 
of the serous membrane should be caused first by means 
of a nitric acid issue. After removal of the pus, the sac 
may be filled with Tinct. Jodi et Aqua 7, to be drawn off 
again at once; and to prevent closure of the opening, it 
may be touched with Arg. nitr. or Sol. Ferri persu/f.', or 
some rubber tubing may be left in it. 

Vaccination — The matter should be taken on the 
seventh or eighth day, before an inflamed areola is 
spread around the vesicle; and it should be lymph, clear 



Vagina. 443 

and transparent, not purulent or discolored by blood. 
If it is desired to preserve the lymph, it may be taken 
on ivory paints or pointed quills; or, what is still better, 
it shouldbc withdrawn from the vesiclesin glass capillary 
tubes, which are to be sealed at once by means of a spir- 
it-lamp. The scab, which exfoliates, and falls off be- 
tween the eighteenth and twenty-fifth day, made into 
a paste with water, is also used; but the lymph is to be 
preferred to the crust, though inclosed in wax, and cov- 
ered with tin foil, the latter w T ill retain its activity for a 
considerable time. As regards the introduction of the 
virus, the situation for it should be on the outside of the 
left arm, near the insertion of the deltoid, and should be 
done by means of slight punctures or minute scarifica- 
tions, made with a common lancet, or by scraping away 
the epidermis with the ivory point, having before moist- 
ened the dried lymph by a momentary exposure to 
steam. It need scarcely be mentioned, that, whenever 
possible, the lymph should be applied directly from 
one arm to another. 

Vagina — Tv/^/^^^^^^^consistsinanexquisitesensibility 
of the vagina, due to a hyperoesthetic condition of thecar- 
unculse after laceration of the hymen during normal coi- 
tion, which whenever touched, causes irregular or spasmo- 
dic contractions of the organ, so that even a finger can- 
not be introduced. An attempt at intercourse is utterly 
impossible, on account of the agonizing pain the act 
produces. See Dyspareunia. Treatment — In the symp- 
tomatic spasm, which is continuous, and may be the 
result from disease of the uterus, vagina or rectum; 
even from hemorrhoids and prolapse of intestines, the 
cause must be removed. The idiopathic form, which is 



444 Vagina. 

of an intermittent character, requires injections of warm 
water, medicated Or not (365); Belladonna or Iodoform 
(350 & 56); or Cocaine (330) and other soothing appli- 
cations. Sometimes it may be necessary to remove the 
hymen with scissors, or to incise the perineum. In most 
cases it will be sufficient to introduce into the vagina a 
large plug of cotton or a conical glass speculum to be re- 
tained there, by means of a T bandage, for about half 
an hour every day. Should the introduction of the plug 
or dilator be too painful, the patient must be anaesthe- 
tized, and the ostium vaginm distended by a trivalve 
or quadrivalve. 

Vaginal Discharges are either mucous, purulent, muco- 
purulent or watery, according to the part affected, and 
the disease, which gives rise to it. In addition to the 
causes enumerated under the head of leucorrhoea, there 
may be mentioned still a mucous discharge due to salpin- 
gitis, when the products of inflammation escape through 
uterus and vagina. In these cases a tumor generally 
marks the position of the Fallopian tube, resp. tubes, 
and considerable pain about the part, followed by a sud- 
den sensation of giving way usually precedes the dis- 
charge, which at these times is more or less profuse. 
In children a mucous discharge frequently accompanies 
scarlatina and other exhausting diseases; sometimes it 
is connected with dentition, if there be a scrofulous 
habit, and occasionally it may be traced to want of 
cleanliness; but the most common cause is without doubt 
local irritation, in consequence of the presence of 
thread-worms in the rectum or their migration into the 
vulva. Treatment — Aside from Zinc (338) locally, en- 
emata (377) with Calomel, followed by 01. Ricini every 



Vaginitis. 445 

third night, if due to worms. In scrofulosis Mercury, 
Iodine or Potassa (pp. 13,15 & 18), preceded by a cathar- 
tic (p. 93). Vaginal discharges in adults are more fully 
discussed in the paragraph on leucorrhoea. If from 
nervous disturbance, it must be treated with applica- 
tions to the spine, blisters, cauterization, issues, or the 
red-hot iron. If it be due to excrescences in the vagi- 
na and vestibuhtm — a result from want of cleanliness, 
chronic inflammation of those parts, or sequels of ven- 
ereal disease — applications of Cuprum (340) will be of 
service; or the warts may be ejrc/se(/with a pair of curv- 
ed scissors, whilst they are grasped with a tenaculum or 
a pair of small forceps, and the cut surface cauterized 
with lunar caustic. 

Vaginitis catarrhalis, which may be produced by ex- 
posure to cold, injury from parturition, pessaries or coi- 
tus, disordered state of the blood and the like causes, is 
characterized by more or less swelling of labia and va- 
gina, throbbing heat and great tenderness on intro- 
duction of the finger, in conjunction with excoriations 
of the part around the vulva, profuse purulent leucor- 
rhoea, frequent desire to pass water, and violent pel- 
vic pains. Sometimes the inflammation extends to the 
cervix uteri, and the speculum will usually reveal the 
vagina much congested, its surface abraded, and in severe 
cases covered with follicular ulcerations. Urethritis, 
endometritis, salpingitis and pelvic peritonitis may be 
complications. 

The specific form, caused by infection, cannot be differ- 
entiated from a discharge arising from intrinsic sources; 
but may be suspected if the inflammation develops 
with great activity and violence especially in women, 



446 Vagina, 

previously free from vaginal discharges; if it be accom- 
panied with marked urethritis and bubo; and if it has 
been trasmitted to the male by coition. The granular 
form is generally chronic, and without being necessari- 
ly specific, may produce in the male gonorrhoea. When 
occurring during pregnancy, accompanied by i^ruritus 
vulvce and lichenous eruptions about the pubes, this 
form will, after parturition, usually disappear without 
medication. 

Treatment — In the acute stage, a cathartic (pp. 92 & 
96); or Mitre (p. 56) in conjunction with soothing injec- 
tions (358), and if necessary anodyne suppositories in 
rectum (375). To relieve ardor urince, akalies (p. 54). 
Later, Copaiva (p. 48), with astringent injections (336 & 
361). In severe cases, whether specific or no, or chronic 
ones, if very obstinate, it may be required to paint the 
vagina twice a week with Argentum (343) — a bivalve 
will suffice for this procedure, if Sim's speculum should 
not be at hand — , and then to introduce a medicated 
tampon (359 & 60), just large enough, to prevent the sur- 
faces of the vagina from rubbing against each other. 
When the disease becomes less severe, the tampons, 
which should remain in the vagina for two days at a 
time, may be thoroughly covered with boracic acid in 
powder. During pregnancy, especially of very nervous 
women, only injections of tepid water, resp. frequent 
ablutions should be used. If complicated with endome- 
tritis, the cervix should thoroughly be dilated (not with 
tents, but under ether, if necessary), and, a strip of io- 
doform gauze passed into the uterus, so as to protrude 
from the os, for the purpose of establishing a free 
drainage. See Endometritis. 



Fistula. 447 

Atresia Vagi nee — Imperforate vagina consists in a 
complete closure of the orifice of the vagina by the hy- 
men, which on account of its retaining the menstrual 
blood, will be found slightly bulging. Aside from per- 
cussion of the enlarged uterus, which may be felt some- 
times several inches above the superior strait, the dis- 
tension by fluid of the vagina can easily be ascertained 
by means of a finger in the rectum and a catheter in the 
bladder. Treatment — A crucial incision should be made 
with a bistoury to evacuate the blood, and septicaemia 
from putrid matter prevented by warm antiseptic injec- 
tions (368 & 397); then, after havingthe abdomen prop- 
erly bandaged, the patient should be confined to the bed 
for a few days. 

Cystic Tumor of the Vagina consists in the enlarge- 
ment of one or more follicles in consequence of obstruc- 
tion of the orifice, caused by inflammatory action. It is 
movable and painless, and if very small, will not cause 
any annoyance, if large, it will however not only in- 
terfere with defecation but also with coition and par- 
turition. Treatment — A free incision into the tumor, 
followed for a few days by injections with soap and 
water. For Vaginal Prolapse, Cgstocele, Iiectocele and 
Fnterocele, see Hernia. 

Fistula — Vesico-vaginal, signifies a communication be- 
tween the bladder and vagina, generally a result from 
sloughing of the parts after a tedious labor, and char- 
acterized by constant dribbling of urine. Treatment — 
As soon as it is discovered, the patient should be made 
to lie on her stomach, and the healing promoted by a 
wash of soap and water, or astringent injections (359-61). 
Sometimes it is expedient to apply the cautery at a black 



448 Varicelli. 

heat to the edges of the fistula at intervals of, from ten 
to thirty days, so as to prevent sloughing; or in old 
cases, caustic to the thickened edges; and as a tempo- 
rary relief a sponge pessary to retain the dribbling. If 
these means fail, an operation must be resorted to. In 
recto-vaginal fistula there are in addition mild laxatives 
indicated (p. 95); but if after a time, the aperture does 
not close, it must be operated upon. 

Varicelli — A specific eruption of vesicles, which af- 
ter the fifth day begin to dry into little scabs. The 
eruption, which is generally preceded for twenty-four 
hours by a slight constitutional disturbance, is usually 
called chickenpox, if the size of the vesicles does not ex- 
ceed that of a lentil; they take the name of swinepox, 
if they are as big as a split cherry stone. Medication 
not required. 

Varicocele or Spermatocele signifies a varicose 
state of the spermatic cord, induced by weakness of ve- 
nous structure, combined with obtruction to the return 
of blood through corpulency, constipation and the like. 
If affecting both sides, it is like piles (varix of the hem- 
orrhoidal veins), an accompaniment of enlarged and dis- 
eased liver pressing upon the vena cava inferior. In 
women the enlargement of the veins of the labia forms 
a soft tumor, which on walking increases in size and 
causes pain; but which disappears in the recumbent po- 
sition. Treatment in males — A suspensory with cold and 
astringent lotions to scrotum (299); in females, aside 
from cold bathing, a truss or T bandage with a pad. 

Varicose Veins or Varix — Dilated veins, which pre- 
sent a tortuous, knotted and convoluted appearance, 
where valves are incapable of preventing the reflux of the 



Variola. 419 

blood, and affecting, aside from the scrotum (varicocele) 
and rectum (hemorrhoids), usually the legs. They cause 
not only pain, weight and fatigue on taking exercise, but 
lead often to excoriations of the skin and even ulcers. 
Treatment — Firm pressure by means of a pad and band- 
age or elastic stockings, with cold and astringent lotions 
(Ferr. chlor.) will generally give relief, especially if con- 
stipation be avoided. As a radical cure, Faradization 
(p. 150); or subcutaneous acupressure, by which the in- 
clusion of skin in the ligature, and consequently much 
pain and soreness, are obviated, may be performed. 

Variola — Smallpox designates an eruptive fever, 
eminently contagious, which, when occurring in subjects 
who have been vaccinated, is called Varioloid or Modi- 
fied Smallpox, on account of the disease being rendered 
less violent by the vaccine. It is characterized by a re- 
mittent fever, followed in two or three days by an ex- 
anthem, which appears before, or at least simultaneously 
with the cutaneous eruption, in mouth and throat, as 
round and whitish spots, peculiar to eruptions on mu- 
cous membrane. The papules on the skin which gen- 
erally show first on the face, neck and wrists, whence 
they spread over the body, are to the touch granular, 
hard, and deep-seated. They turn soon into vesicles, 
which, presenting an umbilicated shape — the pathognom- 
ic central depression — form, after having become pus- 
tules, ultimately, a scab. Scarlatina and measles are 
easily differentiated; for, aside from the nasal catarrh, 
which precedes the one, and the throat affection, which 
accompanies the other, in neither is the fever remitting 
or ceasing with the appearance of the exanthem; and as 
regards varicelli, the eruption is from the first vesicular, 



450 Vertigo. 

without taking into account the insignificance of the 
whole disease. Moreover a mustard plaster applied to 
any part of the body, will not only bring out the erup- 
tion 24-36 hours sooner than usual, so that a diagnosis 
may be made on the first day of the fever; but by this 
means the eruption may be also invited to a particular 
part — abdomen, etc. — and thus the pitting of the face 
avoided; or in malignant cases, a fatal termination. 

Treatment — Su/fo-carbol and sulfites (pp. 16 & 19), 
in conjunction with evaporating lotion s; or Iodine, Chloro- 
form, Collodion, etc. (413 & 414), and evacuation of the 
vesicles by means of a fine needle to prevent the dis- 
figuration caused by pitting. Iodoform (401) is said to 
prevent pustules. In hyperpyrexia, sponging or the wet 
sheet (420). 

Version. See Uterus (Displacements). 

Vertigo— Dizziness or swimming of the head is, un- 
less a symptom of some cerebral or womb disease, an 
individual functional affection (Meniere* 's disease), char- 
acterized by a sensation, similar to that, caused by con- 
tinued rotatory movements, so as to be unable to stand 
without support, combined with forgetfulness. It is 
incident, 6. g. to excessive venery, and smoking of 
too much or too strong tobacco. Treatment according 
to cause — Digital, (p. 78); in aural vertigo, Quinine (p. 76). 

Vision. See Eye. 

Vomiting and Nausea — A sick feeling combined or 
no, with a forcible ejection of the contents of the stom- 
ach through the mouth, may be due to cerebral or kid- 
ney disease, or to gastritis, gastric ulcer and other les- 
ions of the stomach; but it occurs also in cases of chron- 
ic dyspepsia, where the stomach seems to be intolerant 



Vulva. 451 

of all forms of nourishment; sometimes rupture is the 
cause (see Hernia — p. 262); and in women, it is fre- 
quently a sign of pregnancy. Treatment — Belladonna, 
Camphora, Cyan or Chloroform (43, 56, 61 & 67), Creo- 
sote and Strychnos (138 & 184), all are employed, and 
will occasionally be of service; or Calomel v. Hydr. c. Creta 
in small doses; a small piece of ice swallowed, will act 
sometimes like a charm. Bismuth or Pepsin (pp. 46 & 
84), see Dyspepsia; Aq. Calcis or Potass (119) if chronic; 
Alum (p. 62) in consumption from cough; if sarcina, 
sulfites (33), see Sarcina. In vomiting of pregnancy, in 
addition to those named, Brom, Ipecacuanha (46 & 181); 
Aq. Calcis c. Lacte or Acid, citric, (pp. 42 & 56); Cerium 
and Morphia (pp. 29 &37); if hysterical, Cocaine (pp. 11 
& 115); if from alcoholism, Gelsemium, Capsicum (pp. 
33 & 15); Sol. Fowl, half a drop in water half-hourly. 
Iodine (p. 15), is said to check the vomiting in cholera. 
Vomiting in infants, if from mother's milk, will stop 
upon weaning. 

Vulva — Hyperesthesia. Excessive sensibility may 
involve the whole surface of the vulva, or it may be 
confined to the vestibule, one labium {minus) , or to the 
meatus. In any case it makes sexual intercourse very 
painful, even with a large and otherwise healthy ostium 
vaginae. Unless due to an irritable caruncle (see Ure- 
thra), it is either idiopathic, or associated with chronic 
vulvitis. Treatment is essentially local — Alum, Borax, 
Tannin (340 & 46); Belladonna or Cocaine (350 & 396); 
though tonic cathartics (jp. 95) may be sometimes of service. 

Pruritus Vulvae — Itching of the part has a multitude 
of causes: Exclusive local inflammations, as vulvitis or 
vaginitis; or irritation produced by vaginal discharges^ 



452 Vulva. 

eruptions, or parasites, it may be due to scrofula, sup- 
pression of menses, excessive heat of the season, indo- 
lent habits, and not seldom, to want of cleanliness. Pru- 
ritus pudendi is sometimes constant, sometimes inter- 
mittent, and may ultimately lead to complete nervous 
derangement and a general break-down of the constitu- 
tion. Treatment — Above all, removal of cause, if pos- 
sible. Calomel or salines (pp. 92 & 96), if plethora; So- 
da or Aloes (191 & 197) according to indications. Lo- 
cally, Alum, Borax, Plumbum, Phenol (337 & 46); Cam- 
phora, Bismuth, Zinc (339, 345 & 59); Chloroform and Cre- 
osote or A tropin (350, 51 & 56). In diabetes, the parts 
should be bathed and protected with some ointment after 
urination; and where bristly hairs are found on the mu- 
cous surface of the labia majora they should be remov- 
ed. A magnifying glass (263) may sometimes be nec- 
essary to discover them. 

Vulvitis — Inflammation of the vulva is characterized 
by swelling and heat of the parts, attended by burning 
and itching; and if the urethra be involved, scalding in 
micturition. In the purulent form this first stage will 
be followed by superficial ulcers, which may appear all 
over the surface of the vulva; whilst in the follicular 
form the increased, sometimes very offensive smelling 
secretion, is limited to the glands — if the muciparous 
follicles are chiefly affected, the mucosa of the vulva, 
especially on the edges of the lower vaginal rugce, the 
nymphce and carunculce, will be found intensely red in 
spots or patches, which bleed on the slightest irritation; 
and if the sebaceous and pilif erous glands are principal- 
ly involved, little red papillae will cover the surface of 
the labia majora et minora, and the base of the clitoris. 



Inflammations. 453 

Both forms may result from vaginitis, exanthemata, want 
of cleanliness, friction and onanism, or excessive vene- 
ry, Treatment — Saline cathartics (p. 96) with cooling 
and emollient applications (837). Afterwards Argentum 
nitricum or Ferrum persulf. (343 & 45). The parts should 
be constantly kept dusted with Lycopodium, Bismuth 
or starch. 

The gangrenous form begins with a small patch or 
vesicle of a blackish hue, which leaves soon an ulcer. 
As the purplish oedematous state of the labia, in con- 
junction with the grave constitutional symptoms, show- 
ing its connection with puerperal and other continued 
fevers, renders the diagnosis perfectly easy — with diph- 
theria it cannot possibly be confounded on account of the 
absence of false membranes — there should be no delay 
for a prompt and energetic treatment. Aside from a nu- 
tritious diet, wine and other stimulants, a powerful caus- 
tic: The actual cautery or Acidum nitricum vel hydro- 
chloratum should be used at once for destroying the gan- 
grenous spots (the patient being anaesthetized), and then 
the whole covered with antiseptic poultices. Internally 
Chininum cum Ferro (p. 11). Noma affects sometimes 
the labia pudendi of young female children: After two 
or three days of low fever, the little patient is observed 
to suffer considerable while making water; and on ex- 
amination the labia present a livid, erysipelatous red- 
ness and vesications, that are rapidly followed by pha- 
gedenic ulcers. The disease, which, in its causes, na- 
ture and symptoms resembles cancrum oris, must be 
treated on the same principles as the latter affection. 

Phlegmonous Inflammation of (he labia major a com- 
mences like acute abscess elsewhere, with fever; throbb- 



454 Vulva. 

ing pain; bright redness; and much swelling: firm in 
the center and cedematous around. The formation of 
pus is indicated by an abatement of the fever and pain, 
which latter is converted into a sense of weight and 
tension. Care must be taken to differentiate phlegmon 
from enterocele (see Hernia pudendi) or displacement 
of an ovary. Serous engorgement and bloody tumor 
(see Hydrocele resp. Hematocele), even oedema labio- 
rum and vulvitis have been mistaken for it. Treatment 
— Saline cathartics (p. 95) with cold compresses or lead 
and opium wash (337) at the beginning; afterwards poul- 
tices, and as soon as there are signs of fluctuation, 
the knife. 

Abscess of the vulvo-vaginal glands is characterized 
by a hard, painful, and perhaps fluctuating tumor about 
the size of a small egg, with a limited and distinct 
globular outline, which is easily distinguished from a 
cyst by the presence of inflammation. Treatment like 
that indicated for phlegmonous inflammation. If the 
abscess does not open of itself: the lancet. 

Hypertrophy of Nymphce unless congenital, is gener- 
ally due to excessive excitement, or syphilis. If they 
are so much changed as to interfere with sexual inter- 
course or walking, they must be excised with curved 
scissors, after having passed a number of threads through 
the roots, so that the borders of the wound may be 
brought together and united by first intention. As a 
rule, cauterization of the cut surface suffices to stop the 
bleeding; for though the labia interna are more vascu- 
lar than the externa, the vessels are too small to pro- 
duce much hemorrhage. 

Eruptive Diseases of the Vulva usually create sooner 



Wounds. 455 

or later vulvitis, which has to be taken into account in 
the treatment of the latter, since they require the same 
remedies as they do in other parts of the body. Pruri- 
tus is one of the most constant signs, and the itching, 
which it produces often first attracts attention to their 
presence. In prurigo the vulva presents large, scattered 
papules, which are generally denuded at their points of 
cuticle. Lichen shows more numerous papules, which 
rest upon a thickened and somewhat indurated surface. 

Acne consists in engorgement of the sebaceous folli- 
cles, which stud the labial surfaces. Eczema, which in 
diabetes and vesicovaginal fistula often constitutes a 
very troublesome complication, presents vesicles, which, 
as an acute disorder, may rapidly heal again; but some- 
times there are successive crops of them, which will ex- 
haust the strength of the patient in consequence of the 
nervous excitement and irritability they occasion. Ery- 
sipelas and Erythema are always accompanied by graver 
symptoms, than when affecting other parts. 

Wakefulness. See Insomnia. 

Warts. See Skin (Neoplasms). 

Weakness. See Debility, resp. Impotenz. 

Whites. See Leucorrhoea. 

Whitlow. See Onychia. 

Worms. See Helminthiasis. 

Wounds — A solution of continuity or separation of 
continuous parts by violence, is usually directed from 
the cutaneous or mucous surfaces; but sometimes it is 
caused within the body by broken bones, etc. Incised 
wounds (those made by a clean-cutting instrument), 
which are usually produced with the least violence, gen- 
erally admit most easily of repair, while lacerated and 



456 Wounds. 

contused ones are more prone to slough or suppurate, 
though they do not bleed much. Punctured wounds 
are dangerous from the possibility that deep-seated ex- 
travasation of blood or abscess may follow. Treat- 
ment consists in checking bleeding, which in most cases 
may be accomplished by a raised position, moderate 
pressure, cold compresses and styptic applications (415 
& 16), see Hemorrhage; removal of foreign bodies (with 
forceps or sponge and water); bringing the divided 
parts into their natural position and keeping them in 
union — which may be obtained with strips of adhesive 
plaster, covered by a compress or bandage, with collo- 
dion or by sutures (interrupted, twisted, continuous or 
quill, as maybe required); and lastly by preventing sup- 
puration and fever — which is most effectually done by 
the antiseptic method (p. 139). 

If any small portion of the body (as finger, part of 
nose for instance), has been completely cut off, it may 
unite again, even after several hours, if it is reap- 
plied, retained with plaster or by sutures, and wrapped 
up, so as to preserve its temperature. Open wounds will 
heal best by forming a scab: Pledgets of lint, soaked in 
blood, friars balsam, or Quebracho are placed on the 
wound to there adhere; or by the use of simple water 
dressing with some antiseptic. If there be pain, rest- 
lessness and shivering, an incision may be necessary. 
Punctured wounds should be kept at perfect rest and 
bandaged sufficient firmly to prevent subcutaneous ooz- 
ing of the blood, which is the most likely cause of in- 
flammation. Gun-shot wounds of the thorax or abdo- 
men are always followed by more or less collapse, 
from which the patient should not be roused too soon, 



Wounds. 457 

if large vessels are supposed to have been injured. He 
should be placed on a bed, with his head low, and care- 
fully watched in order to prevent the collapse from go- 
ing too far, by the judicious application of stimulants, 
warmth, etc. In case of hemorrhage, pressure and the 
l ; gature (if intermediary, which may occur after reac- 
tion has taken place, or secondary, which may take place 
up to the 25th day after the injury, the same treatment, 
see Hemorrhage). The exploration of the wound should 
be made, if possible, before swelling and oedema have 
come on. Sometimes the right forefinger, aided by 
counter-pressure of the other hand will suffice, espe- 
cially if the wound be dilated, to allow its entrance; but 
generally probes for this purpose have to be resorted 
to. The extraction of the ball is best accomplished by 
means of forceps; for small, loose fragments, a bullet- 
scoop may be of service. Gun-shot wounds of the scalp 
with fracture of the skull should be carefully examined 
with the finger, if there is a depression. In this case 
the depressed bone should be lifted by means of an ele- 
vator, especially if there are symptoms of compression; 
if not, the operation may be delayed until cerebral 
symptoms appear. In fracture of the skull without de- 
pression, cold compresses to the head, in conjunction 
with cathartics (p. 88), and rest. The formation of pus, 
which would be indicated by severe rigors with head 
symptoms, coming on from fifteen to thirty days after 
the injury, requires evacuation, after having removed a 
portion of bone with the trephine. Gun-shot icounds 
of the face are sometimes complicated with injury to the 
brain. Plastic surgery may be occasionally desirable, 
and ligature of the carotis necessary (416). All loose 



45 S Wounds. 

spicula of bone should be removed, the parts by sutures 
adjusted, and covered with light antiseptic dressings. If 
the jaw be fractured, it should be maintained in posi- 
tion by means of the perforated wire or gutta-percha 
splint. Wounds of arteries require first of all, firm 
pressure to arrest the bleeding, by means of a finger on 
the vessel; in wide and deep wounds, by placing the fin- 
ger on the exact spots where the blood issues from; by 
tying a handkerchief with a stone round the limb and 
twisting it tightly with a stick in default of a tourni- 
quet. If the arteries are numerous and small, pressure 
by means of cold compresses in conjunction with styp- 
tics will suffice, Tinct. vel Liq. Ferri chlorati, Argantum 
nitricum, 01. Terabinthince, Creosote, A pinch or a pidl 
with the forceps will often cause small vessels to cease 
bleeding. Many obstinate hemorrhages from small ves- 
sels cease, when the wound is cleared of coagulum, and 
the bleeding part sluiced with cold water, and exposed 
to the air for some time, before it is bound up again. 
The actual cautery at black heat will be indicated for 
arteries, that either* cannot be tied, or are too diseased 
to hold the ligature. If the vessels are large, # the liga- 
ture (416), or still better, acupressure or torsion will 
be the proper thing. 

The method of employing acupressure is either, by 
passing a needle of, from three to six inches in length 
(according to the thickness of the wound) through one of 
the flaps of a wound over the vessel in the same way as 
we would fasten with a pin the stalk of a flower to our 
coat; or a sewing needle is passed behind the vessel, and 
a fine iron wire having been slipped over its point, is 
brought over the vessel tightly enough to close it, and 



Wounds. 459 

secured with a slight twist round the eye-end. Torsion 
is performed by drawing out the vessel from its sheath 
by a pair of broad-pointed spring-forceps, and then 
twisting it round freely as far as its natural connections 
above will allow; or by fixing the vessel with one pair 
of forceps a quarter or half an inch from the end, and then 
twisting the end with another pair till it does not untwist 
itself. Arteries situated immediately over a bone may be 
closed with & graduated compress. A puncture or partial 
division of an artery is generally more troublesome than 
complete division, as neither contraction nor retraction of 
the vessel can take place; therefore small arteries should 
in these cases be completely divided. 

In cases of arterial hemorrhage, which there is dif- 
ficulty in restraining by ligature or otherwise, the pa- 
tient should be kept in the recumbent posture. The 
diet should consist of milk, broth, and such substances, 
which nourish without stimulating; and Opium (p. 35) 
may be given to tranquilize the heart's action. If life 
is endangered by the loss of blood, the head must be 
kept low; beef -tea with brandy (p. 72) be given frequent- 
ly by spoonfuls, and small doses of Opium every three 
or four hours. As a last resource, transfusion should 
be resorted to. 

Wounds of veins are as a rule easily closed by pres- 
sure in conjunction with a raised position; sometimes 
however they may require the ligature or acupressure. 

Wounds from stings and bites of insects must be cau- 
terized with Aqua Ammoniac, Acid, nitr. or Soda (407). A 
wound from a bite of a rabid animal should be well sucked, 
a ligature put above the bitten part, and as soon as possi- 
ble cut out and freely cauterized with Argenti Nitras. In 



460 Wryneck. 

Snakebite, brandy may be exhibited freely; Ammonii 
Carbonas or Cedron (pp. 10 & 73); Mangan (403) has 
been recommended. Poisoned wounds {Ptomain) from 
dissection or from operation will cause blood poisoning: 
Inflammation of the glands, abscesses, erysipelas, etc., 
accompanied by constitutional symptoms. They claim 
aside from tonics (p. 7l) and cathartics (p. 71) an antisep 
tic treatment: Resorcin, Mercury or Phenol (396-98). 
Zinc or Benzol (403); Medicated cotton (416) etc., see 
Septicaemia. 

Wristdrop. See Paralysis from lead poison. 

Writer's Cramp. See Spasm. 

Wryneck (Caput obstipum) — A peculiar distortion, 
in which the head is bent down towards one shoulder, 
the face being turned to the opposite side; and unless 
congenital, dependent on some intra-cranial or spinal 
affection of the spinal accessory, or what is more usual, 
an inflammatory spasm of one of the sterno-cleido-mas- 
toidei, which feels hot and tender, and upon the slight- 
est motion, painful, (see Spasm and Myalgia — Torti- 
collis rheum aticus). Treatment — In fresh cases, next to 
perfect rest, poultices and fomentations, a generous diet 
in conjunction with cathartics (p. 88) and tonics, espe- 
cially Quinine and Zinc (pp. 77 & 87). The use of a ma- 
chine or gutta-percha collar with a chin and shoulder 
piece, to keep up extension in cases of no long duration. 
The congenital form will probably require division of 
the sternal origin of the muscles. 

Yellow Fever. See Fever. 



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